Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention.
Adult
Aged
Australia
Blood Pressure
/ physiology
Coronary Circulation
/ physiology
Female
Follow-Up Studies
Hemodynamics
/ physiology
Humans
Hypertension
/ complications
Male
Middle Aged
Myocardial Ischemia
/ physiopathology
Percutaneous Coronary Intervention
Postoperative Complications
/ etiology
Preoperative Care
Prospective Studies
Registries
Risk Factors
ST Elevation Myocardial Infarction
/ physiopathology
Treatment Outcome
blood pressure
coronary artery disease
outcomes
percutaneous coronary intervention
pulse pressure
Journal
Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365
Informations de publication
Date de publication:
11 06 2019
11 06 2019
Historique:
received:
07
01
2019
revised:
06
03
2019
accepted:
07
03
2019
entrez:
8
6
2019
pubmed:
7
6
2019
medline:
28
3
2020
Statut:
ppublish
Résumé
High systolic blood pressure (SBP) increases cardiac afterload, whereas low diastolic blood pressure (DBP) may lead to impaired coronary perfusion. Thus, wide pulse pressure (high systolic, low diastolic [HSLD]) may contribute to myocardial ischemia and also be a predictor of adverse cardiovascular events. The purpose of this study was to determine the relationship between pre-procedural blood pressure and long-term outcome following percutaneous coronary intervention (PCI). The study included 10,876 consecutive patients between August 2009 and December 2016 from the Melbourne Interventional Group registry undergoing PCI with pre-procedural blood pressure recorded. Patients with ST-segment elevation myocardial infarction, cardiogenic shock, and out-of-hospital cardiac arrest were excluded. Patients were divided into 4 groups according to SBP (high ≥120 mm Hg, low <120 mm Hg) and DBP (high >70 mm Hg, low ≤70 mm Hg). Mean pulse pressure was 60 ± 21 mm Hg. Patients with HSLD were older and more frequently women, with higher rates of hypercholesterolemia, renal impairment, diabetes, and multivessel and left main disease (all p ≤ 0.0001). There was no difference in 30-day major adverse cardiac events, but at 12 months the HSLD group had a greater incidence of myocardial infarction (p = 0.018) and stroke (p = 0.013). Long-term mortality was highest for HSLD (7.9%) and lowest for low systolic, high diastolic (narrow pulse pressure) at 2.1% (p = 0.0002). Cox regression analysis demonstrated significantly lower long-term mortality in the low systolic, high diastolic cohort (hazard ratio: 0.50; 99% confidence interval: 0.25 to 0.98; p = 0.04). Pulse pressure at the time of index PCI is associated with long-term outcomes following PCI. A wide pulse pressure may serve as a surrogate marker for risk following PCI and represents a potential target for future therapies.
Sections du résumé
BACKGROUND
High systolic blood pressure (SBP) increases cardiac afterload, whereas low diastolic blood pressure (DBP) may lead to impaired coronary perfusion. Thus, wide pulse pressure (high systolic, low diastolic [HSLD]) may contribute to myocardial ischemia and also be a predictor of adverse cardiovascular events.
OBJECTIVES
The purpose of this study was to determine the relationship between pre-procedural blood pressure and long-term outcome following percutaneous coronary intervention (PCI).
METHODS
The study included 10,876 consecutive patients between August 2009 and December 2016 from the Melbourne Interventional Group registry undergoing PCI with pre-procedural blood pressure recorded. Patients with ST-segment elevation myocardial infarction, cardiogenic shock, and out-of-hospital cardiac arrest were excluded. Patients were divided into 4 groups according to SBP (high ≥120 mm Hg, low <120 mm Hg) and DBP (high >70 mm Hg, low ≤70 mm Hg).
RESULTS
Mean pulse pressure was 60 ± 21 mm Hg. Patients with HSLD were older and more frequently women, with higher rates of hypercholesterolemia, renal impairment, diabetes, and multivessel and left main disease (all p ≤ 0.0001). There was no difference in 30-day major adverse cardiac events, but at 12 months the HSLD group had a greater incidence of myocardial infarction (p = 0.018) and stroke (p = 0.013). Long-term mortality was highest for HSLD (7.9%) and lowest for low systolic, high diastolic (narrow pulse pressure) at 2.1% (p = 0.0002). Cox regression analysis demonstrated significantly lower long-term mortality in the low systolic, high diastolic cohort (hazard ratio: 0.50; 99% confidence interval: 0.25 to 0.98; p = 0.04).
CONCLUSIONS
Pulse pressure at the time of index PCI is associated with long-term outcomes following PCI. A wide pulse pressure may serve as a surrogate marker for risk following PCI and represents a potential target for future therapies.
Identifiants
pubmed: 31171090
pii: S0735-1097(19)34786-2
doi: 10.1016/j.jacc.2019.03.493
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2846-2855Investigateurs
Chris Reid
(C)
Nick Andrianopoulos
(N)
Angela Brennan
(A)
Diem Dinh
(D)
Chris Reid
(C)
Andrew Ajani
(A)
Stephen Duffy
(S)
David Clark
(D)
Melanie Freeman
(M)
Chin Hiew
(C)
Nick Andrianopoulos
(N)
Ernesto Oqueli
(E)
Angela Brennan
(A)
S J Duffy
(SJ)
J A Shaw
(JA)
A Walton
(A)
A Dart
(A)
A Broughton
(A)
J Federman
(J)
C Keighley
(C)
C Hengel
(C)
K H Peter
(KH)
D Stub
(D)
W Chan
(W)
J Warren
(J)
J O'Brien
(J)
L Selkrig
(L)
R Huntington
(R)
D J Clark
(DJ)
O Farouque
(O)
M Horrigan
(M)
J Johns
(J)
L Oliver
(L)
J Brennan
(J)
R Chan
(R)
G Proimos
(G)
T Dortimer
(T)
B Chan
(B)
V Nadurata
(V)
R Huq
(R)
D Fernando
(D)
A Al-Fiadh
(A)
M Yudi
(M)
H Sugumar
(H)
J Ramchand
(J)
H Han
(H)
S Picardo
(S)
L Brown
(L)
E Oqueli
(E)
C Hengel
(C)
A Sharma
(A)
B Zhu
(B)
N Ryan
(N)
T Harrison
(T)
G New
(G)
L Roberts
(L)
M Freeman
(M)
M Rowe
(M)
G Proimos
(G)
Y Cheong
(Y)
C Goods
(C)
D Fernando
(D)
A Teh
(A)
S Parfrey
(S)
J Ramzy
(J)
A Koshy
(A)
P Venkataraman
(P)
D Flannery
(D)
C Hiew
(C)
M Sebastian
(M)
T Yip
(T)
Michael Mok
(M)
C Jaworski
(C)
A Hutchinson
(A)
C Cimenkaya
(C)
P Ngu
(P)
B Khialani
(B)
H Salehi
(H)
M Turner
(M)
J Dyson
(J)
B McDonald
(B)
D Van Den Nouwelant
(D)
K Halliburton
(K)
C Reid
(C)
N Andrianopoulos
(N)
A L Brennan
(AL)
D Dinh
(D)
B P Yan
(BP)
A E Ajani
(AE)
R Warren
(R)
D Eccleston
(D)
J Lefkovits
(J)
R Iyer
(R)
R Gurvitch
(R)
W Wilson
(W)
M Brooks
(M)
S Biswas
(S)
J Yeoh
(J)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. All rights reserved.