Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention

Nanayakkara, Shane; Kaye, David M.; Kingwell, Bronwyn A.; Reid, C.; Oqueli, Ernesto; Duffy, Stephen J.; Shaw, James A.; Walton, Antony; Dart, Anthony M.; Broughton, Archer; Federman, J.; Keighley, Craig S.; Peter, K; Stub, Dion; Chan, William; Warren, Josephine; O’Brien, Jessica; Selkrig, L.; Huntington, Robert W.; Clark, David; Farouque, Omar; Horrigan, M.; Johns, Jennifer; Oliver, Léopold; Brennan, John P.; Chan, RW; Dortimer, T.; Chan, Boniface; Nadurata, Voltaire; Huq, Raqib; Al-Fiadh, A.; Yudi, M.; Sugumar, Hariharan; Ramchand, Jay; Han, Hailong; Picardo, S.; Brown, Laurence; Oqueli, E.; Hengel, C.; Sharma, Anand; Zhu, Bao‐Ting; Ryan, Nicola; Harrison, Theresa M.; New, Gishel; Roberts, L.; Freeman, Melanie; Rowe, Michael H.; Proimos, G.; Cheong, Y.; Goods, C.; Fernando, D.; Teh, A.; Parfrey, S.; Ramzy, J.; Koshy, A.; Venkataraman, P.; Flannery, D.; Hiew, C.; Sebastian, Martin; Yip, T.; Mok, Michael; Jaworski, Catherine; Hutchinson, A.; Cimenkaya, C.; Ngu, P.; Khialani, Bharat; Salehi, Hamid; Turner, Michael J.; Dyson, Jeanette; McDonald, Bernard; Nouwelant, D. Van Den; Halliburton, K.; Reid, C.; Andrianopoulos, Nick; Brennan, A.; Dinh, D.; Yan, B.; Ajani, A.; Warren, R.; Eccleston, D.; Lefkovits, Jeffrey; Iyer, Ravi N.; Gurvitch, Ronen; Wilson, Walter J.; Brooks, Matthew; Biswas, Sinjini; Yeoh, J.

doi:10.1016/j.jacc.2019.03.493

Cited by 33 publications

(26 citation statements)

References 57 publications

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“…Most recently, a large retrospective analysis associated higher preprocedural PP (high SBP combined with low DBP) with a higher incidence of MI and stroke at 1 year after PCI. 6 Our findings are in part consistent with those previous studies. We found that after adjusting for several confounders, subjects with high baseline PP who underwent PCI were at an increased risk (9% risk increase along the 2 years) of having the combination of clinically relevant ischemic events and safety-related bleeding events, namely NACE.…”

Section: Discussionsupporting

confidence: 93%

“…5 Recently, a retrospective study demonstrated that the combination of high SBP and low DBPda wide PPdbefore PCI is associated with myocardial infarction and stroke at 1 year after the procedure. 6 Although previous studies have reported PP predicting poor clinical outcomes after PCI, they were mainly conducted in registries with outdated PCI approaches (balloon angioplasty and bare metal stent implantation) in selected PCI population. Thus, data on PP association with outcomes in clinical trials including a large all-comers population with CAD who have undergone contemporary PCI are lacking.…”

Section: R Esum Ementioning

confidence: 99%

See 1 more Smart Citation

Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS

Faria

Modolo

Chichareon

et al. 2020

Canadian Journal of Cardiology

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Section: Discussionsupporting

confidence: 93%

Section: R Esum Ementioning

confidence: 99%

Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS

Faria

Modolo

Chichareon

et al. 2020

Canadian Journal of Cardiology

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“…We caution, however, that the chronic impact of glucose and insulin per se on arterial stiffness includes a more complex vascular remodeling not seen with the acute metabolic interventions studied here. For example, widened pulse pressure has been associated with DM in many studies [47][48][49] , but we did not see a change in pulse pressure within any protocol of the current study. Acute alterations in arterial stiffness result from changes in endothelial function, vascular tone, heart rate, and other causes, whereas chronic arterial stiffening is mainly due to vascular remodeling, brosis, and calci cation 50 .…”

Section: Discussioncontrasting

confidence: 70%

Insulin Increases Central Aortic Stiffness in Response To Hyperglycemia in Healthy Humans: A Randomized Four-Way Crossover Study

Horton

Jahn

Hartline

et al. 2021

Preprint

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Introduction: Increasing arterial stiffness is a feature of vascular aging that is accelerated by conditions that enhance cardiovascular risk, including diabetes mellitus. Multiple studies demonstrate divergence of carotid-femoral pulse wave velocity and augmentation index in persons with diabetes mellitus, though mechanisms responsible for this are unclear.Materials and Methods: We tested the effect of acutely and independently increasing plasma glucose, plasma insulin, or both on hemodynamic function and markers of arterial stiffness (including carotid-femoral pulse wave velocity, augmentation index, forward and backward wave reflection amplitude, and wave reflection magnitude) in a four-arm, randomized study of healthy young adults.Results: Carotid-femoral pulse wave velocity increased only during hyperglycemic-hyperinsulinemia (+0.36 m/s; p=0.032), while other markers of arterial stiffness did not change (all p>0.05). Heart rate (+3.62 bpm; p=0.009), mean arterial pressure (+4.14 mmHg; p=0.033), central diastolic blood pressure (+4.16 mmHg; p=0.038), and peripheral diastolic blood pressure (+4.09 mmHg; p=0.044) also significantly increased during hyperglycemic-hyperinsulinemia.Conclusions: We conclude that the acute combination of moderate hyperglycemia and hyperinsulinemia preferentially stiffens central elastic arteries. This effect may be due to increased sympathetic activity. (ClinicalTrials.gov number NCT03520569; registered 9 May 2018).

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“…There is some evidence supporting wide PP as a poor prognostic indicator for percutaneous coronary intervention (PCI) with higher rates of postoperative myocardial infarction and stroke, 61,62 although cases of idiopathic peri‐operative wide PP without adverse clinical outcomes have also been described 63 . In a study of 10 876 patients undergoing PCI, patients with wide PP were more often women with higher rates of hypercholesterolemia, kidney dysfunction, diabetes mellitus, and multiple vessel of left main coronary artery disease 62 . Therefore, it is likely that wide PP is instead an indicator of a higher‐risk patient population with a worse prognosis due to poor vascular health and other pre‐existing risk factors.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Wide pulse pressure: A clinical review

Tang

Medeiros

Shah

2020

J of Clinical Hypertension

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Pulse pressure naturally increases over time as individuals’ age due to arteriosclerosis and diffuse vascular stiffening. However, the differential for widened pulse pressure is broad and includes causes of hyperdynamic circulation and high‐output heart failure, such as aortic regurgitation and hyperthyroidism. In the absence of an underlying cause, wide pulse pressure is a sign of deteriorating cardiovascular health and carries increased risk for mortality, disease progression, and adverse clinical outcomes in chronic diseases including cardiovascular disease and chronic kidney disease. Current emphasis of antihypertensive treatment on systolic and diastolic blood pressure does not always address pulse pressure, thus subjecting many patients to an independent risk factor for poor outcomes. Pulse pressure control is more successfully achieved with thiazide diuretics and long‐acting nitrates when compared to other antihypertensive agents, but further research is needed to quantify the additional benefits of pulse pressure control over conventional blood pressure therapy. This case review provides an overview of the pathogenesis, pathologic causes, and treatment of widened pulse pressure and evaluates current evidence for pulse pressure as a predictor of clinical outcomes.

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Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention

Cited by 33 publications

References 57 publications

Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS

Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS

Insulin Increases Central Aortic Stiffness in Response To Hyperglycemia in Healthy Humans: A Randomized Four-Way Crossover Study

Wide pulse pressure: A clinical review

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