Admission blood pressure and 1-year mortality in acute myocardial infarction

Roth, Dominik von; Tulder, Raphael van; Heidinger, Benedikt H.; Herkner, Harald; Schreiber, Wolfgang; Havel, Christof

doi:10.1111/ijcp.12588

Cited by 25 publications

(19 citation statements)

References 24 publications

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“…Excessive vasopressor use may lead to increased afterload and increased oxygen consumption of the heart, thereby aggravating the myocardial damage. On the other hand, hypotension or even low-normal blood pressure at hospital admission is associated with increased mortality in patients with acute myocardial infarction [ 22 ]. In addition, hypotension can decrease coronary perfusion pressure leading to myocardial hypoperfusion and ischaemia and, eventually, cardiovascular collapse [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

et al. 2018

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PurposeWe aimed to determine the feasibility of targeting low-normal or high-normal mean arterial pressure (MAP) after out-of-hospital cardiac arrest (OHCA) and its effect on markers of neurological injury. MethodsIn the Carbon dioxide, Oxygen and Mean arterial pressure After Cardiac Arrest and REsuscitation (COMACARE) trial, we used a 23 factorial design to randomly assign patients after OHCA and resuscitation to low-normal or high-normal levels of arterial carbon dioxide tension, to normoxia or moderate hyperoxia, and to low-normal or high-normal MAP. In this paper we report the results of the low-normal (65–75 mmHg) vs. high-normal (80–100 mmHg) MAP comparison. The primary outcome was the serum concentration of neuron-specific enolase (NSE) at 48 h after cardiac arrest. The feasibility outcome was the difference in MAP between the groups. Secondary outcomes included S100B protein and cardiac troponin (TnT) concentrations, electroencephalography (EEG) findings, cerebral oxygenation and neurological outcome at 6 months after cardiac arrest.ResultsWe recruited 123 patients and included 120 in the final analysis. We found a clear separation in MAP between the groups (p < 0.001). The median (interquartile range) NSE concentration at 48 h was 20.6 µg/L (15.2–34.9 µg/L) in the low-normal MAP group and 22.0 µg/L (13.6–30.9 µg/L) in the high-normal MAP group, p = 0.522. We found no differences in the secondary outcomes.ConclusionsTargeting a specific range of MAP was feasible during post-resuscitation intensive care. However, the blood pressure level did not affect the NSE concentration at 48 h after cardiac arrest, nor any secondary outcomes.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5446-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

et al. 2018

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“…[13] The results of a prospective multicenter observational study on 11,292 Korean patients with STEMI found that those with normal SBP (100-139 mmHg) had a higher risk of in-hospital mortality compared with hypertension patients, but not of all-cause death or MACE. [15] Another study on 3943 patients with acute MI reached a similar conclusion [12]. In addition, using data from more than 10,000 non-ST-elevation ACS patients in two large registries, Lee et al found an independent relationship between lower SBP and in-hospital mortality; hypertension history or use of antihypertensive medication did not affect these associations [14].…”

Section: Plos Onementioning

confidence: 84%

“…[8][9][10][11] Additionally, several studies have previously demonstrated the inverse link between increasing admission SBP and the risk of adverse cardiovascular outcome. [12][13][14][15] However, there is a lack of further investigation into the nonlinear relationship between admission SBP and adverse outcome of AMI patients.…”

Section: Introductionmentioning

confidence: 99%

Association between admission systolic blood pressure and major adverse cardiovascular events in patients with acute myocardial infarction

et al. 2020

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Background Several studies have previously demonstrated that higher systolic blood pressure level means lower risk of adverse cardiovascular outcomes. However, there is a lack of further investigation into the nonlinear relationship between admission systolic blood pressure (SBP) and adverse outcomes of acute myocardial infarction (AMI) patients. Objectives The aim of this study was to investigate the specific relationship between admission SBP and incidence of major adverse cardiovascular events (MACE) in 30 days for AMI patients. Methods and results Using data from the ACS-QUIK trial, we analyzed 21,364 patients from Kerala, India. In univariate linear-regression model, the OR was 0.90 per 10mmHg, the confidence interval (CI) was 95% (0.87-0.92) and P < 0.0001. The generalized additive model (GAM) showed a nearly U-shaped curve between admission SBP and MACE. Using a two-piecewise linear regression model, we calculated an inflection point of 159 mmHg. We found that the higher admission SBP is associated with lower incidence of MACE of AMI patients. In addition, subgroups with different LVEF have distinct effects on blood pressure-related outcomes. Lower SBP has a greater risk when LVEF < 40%. Conclusion The present study revealed the U-shaped relationship between admission SBP and the risk of adverse cardiovascular outcome. The admission SBP could be a marker to provide clinical assessment and treatment.

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“…A 70% relative risk reduction for mortality in the highest vs the lowest BP category was documented. Regarding diastolic BP, levels <60 mm Hg were associated with a worse outcome …”

Section: Admission Blood Pressure and Patient Outcome In Acute Coronamentioning

confidence: 97%

Hypertension and patients with acute coronary syndrome: Putting blood pressure levels into perspective

Κωνσταντίνου

Tsioufis

Koumelli

et al. 2019

J of Clinical Hypertension

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Arterial hypertension is a well‐established cardiovascular risk factor, and blood pressure (BP) control has largely improved the prognosis of hypertensive patients. A number of studies have assessed the role of BP levels in the prognosis of patients with acute coronary syndromes. Pathophysiologic links of hypertension to acute myocardial infarction (MI) include endothelial dysfunction, autonomic nervous system dysregulation, impaired vasoreactivity, and a genetic substrate. A history of hypertension is highly prevalent among patients presenting with MI, and some, but not all, studies have associated it with a worse prognosis. Some data support that low levels of admission and in‐hospital BP may indicate an increased risk for subsequent events. Risk scores used in patients with MI have, therefore, included BP levels and a history of hypertension in their variables. Of note, good long‐term BP control, ideally initiated prior to discharge, should be pursued in order to improve secondary prevention.

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Admission blood pressure and 1-year mortality in acute myocardial infarction

Cited by 25 publications

References 24 publications

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Association between admission systolic blood pressure and major adverse cardiovascular events in patients with acute myocardial infarction

Hypertension and patients with acute coronary syndrome: Putting blood pressure levels into perspective

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