Interarm blood pressure differences and 2-year mortality in acute coronary syndrome patients

Abstract

Background and aims Interarm blood pressure difference (IABPD) was associated with increased cardiovascular and all-cause mortality in various cohorts previously. In this study, we planned to explore the association between the IABPD obtained with simultaneous measurements in both arms and the risk of mortality over a 2-year follow-up of patients with acute coronary syndrome (ACS). Methods Simultaneous blood pressure (BP) measurements were performed during initial admission in patients with ACS. Systolic ≥10 mmHg and diastolic ≥5 mmHg absolute IABPD was defined as cutoff values in this study. The relationship of IABPD and all-cause mortality was assessed using Kaplan–Meier curves and Cox analysis. Results A total of 532 patients with ACS were included in the study. Mean age of the study participants was 60.1 ± 12.6. Patients included in the study were followed for 23.2 ± 7.2 months (median 25.3, min: 0, max: 28.7 months). Survival was assessed using Kaplan–Meier curves. Patients with systolic IABPD ≥ 10 mmHg and systolic IABPD < 10 mmHg had an average survival time of 25.94 ± 0.84 and 25.92 ± 0.38 months (P = 0.925), respectively. Survival times of diastolic IABPD ≥5 mmHg and diastolic IABPD <5 mmHg were 26.44 ± 0.62 and 25.71 ± 0.41 (P = 0.251) months, respectively. Conclusions In the current study, we did not find a significant association between IABPD and all-cause mortality in patients with ACS in 2-years follow-up. Future studies may be required for further evaluation of the prognostic importance of IABPD in patients with ACS.

Association of an inter‐arm systolic blood pressure difference with all‐cause and cardiovascular mortality: A meta‐analysis of cohort studies

“…The median follow‐up duration ranged from 342 days to 16.4 years. Six studies had a prospective cohort design 16 , 18 , 20 , 21 , 24 , 25 and the remainder were retrospective cohort studies. 9 , 17 , 19 , 26 All the study populations contained a proportion of patients with hypertension or diabetes.…”

“…First, there was some moderate heterogeneity in all‐cause comparisons at an IASBPD cutoff of 10 mm Hg. The results of the sensitivity analysis suggested that the study by Kilic and coworkers 20 was the source of this heterogeneity. Their study included patients with ACS and excluded stroke, a history of subclavian artery stenosis, and patients who needed inotropic therapy, all of which can be associated with mortality.…”

“…First, there was some moderate heterogeneity in all-cause comparisons at an IASBPD cutoff of 10 mm Hg. The results of the sensitivity analysis suggested that the study by Kilic and coworkers 20 was the source of this heterogeneity.…”

“… 15 Although a subgroup analysis by Cao and coworkers 12 showed that an IASBPD ≥10 mm Hg when measured simultaneously was associated with increased all‐cause and cardiovascular mortality, several cohort studies of simultaneous BP measurements have been published in the last 8 years. 16 , 17 , 18 , 19 , 20 , 21 Therefore, it was possible for us to perform an updated meta‐analysis to assess the predictive value of an IASBPD for all‐cause and cardiovascular mortality in cohort studies.…”

Association of Increased Inter-arm Blood Pressure Difference with Long-term Clinical Outcomes in Patients with Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention

“…The differences between the present and previous studies should be clarified. Kilic et al investigated the association between the IABPD and all-cause death in 532 patients with acute coronary syndrome (30) and found no significant association between these item at two-year follow-up. The age was younger in their study (mean, 60.1 years old) than in our study (median, 70 years old), but the median follow-up duration was comparable between their study (23.2 months) and our study (694 days [23.1 months]).…”