Prognostic impact of blood pressure and heart rate at admission on in-hospital mortality after primary percutaneous intervention for acute myocardial infarction with ST-segment elevation in western Romania

Abstract

BackgroundThe purpose of this retrospective study was to evaluate the prognostic impact of systolic blood pressure (SBP) and heart rate (HR) on in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) patients, after primary percutaneous intervention (PCI).Patients and methodsThe study included 294 patients admitted for STEMI. They were divided into five groups according to the SBP at admission: group I, <105 mmHg; group II, 105–125 mmHg; group III, 126–140 mmHg; group IV, 141–158 mmHg; and group V, ≥159 mmHg. Increased HR was defined as ≥80 beats per minute (bpm). In-hospital death was defined as all-cause death during admission and classified into cardiac and noncardiac death.ResultsAmong the 294 patients admitted for STEMI, 218 (74%) were men. The mean age was 62±17 years. In-hospital mortality rate was 6% (n=18), with 11 (3.7%) deaths having cardiac causes. The highest mortality was registered in group I (n=9, 16%, P=0.018). Compared to the other groups, group I patients were older (P=0.033), more often smokers (P=0.026), and had a history of myocardial infarction (P=0.003), systemic hypertension (P=0.023), diabetes (P=0.041), or chronic kidney disease (P=0.0200). They more often had a HR ≥80 bpm (P=0.028) and a Killip class 3 or 4 at admission (P=0.020). The peak creatine phosphokinase-MB level was significantly higher in this group (P=0.005), while the angiographic findings more often identified as culprit lesions were the right coronary artery (P=0.005), the left main trunk (P=0.040), or a multivessel coronary artery disease (P=0.044). Multivariate analysis showed that group I patients had a significantly higher risk for both all-cause death (P=0.006) and cardiac death (P=0.003). Patients with HR ≥80 bpm also had higher mortality rates (P=0.0272 for general mortality and P=0.0280 for cardiac mortality).ConclusionThe present study suggests that SBP <105 mmHg and HR ≥80 bpm at admission of STEMI patients are associated with a higher risk of in-hospital death, even after primary PCI.

Resting Heart Rate and Long-Term Outcomes in Patients with Percutaneous Coronary Intervention: Results from a 10-Year Follow-Up of the CORFCHD-PCI Study

“…The association between heart rate and long-term outcomes of patients remains unclear. A study by Bordejevic et al [9] suggested that heart rate ≥80 beats/min in STEMI patients at admission is associated with a higher risk of in-hospital death, even after primary PCI. Wang et al [12] investigated the effect of heart rate on the prognosis of ACS patients in a Chinese population and found that an elevated resting heart rate ≥61 beats/min was associated with an increased risk of MACEs over a one-year period.…”

“…Recently, O'Brien and colleagues observed an association of the heart rate with outcomes after percutaneous coronary intervention (PCI) and found that the heart rate immediately before PCI is an independent predictor of adverse 30-day cardiovascular outcomes [5]. Most studies that evaluated the association of the heart rate with outcomes in STEMI patients have included a follow-up duration of up to 6 months [5–9]. The relationship between heart rate and long-term outcomes of patients with PCI has not been thoroughly investigated.…”

<p>Peri-Procedural Blood Pressure Changes and Their Relationship with MACE in Patients Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study</p>

“…17 The aim of study was to evaluate the shock index (ratio of heart rate/systolic blood pressure on admission) as a predictor of mortality post PPCI in addition to other parameters. 18 Invasively measured shock index before PPCI is the strongest independent predictor of longterm outcome in elderly patients.…”

Reproducibility of Hemodynamic, Cardiac Autonomic Modulation, and Blood Flow Assessments in Patients with Intermittent Claudication

“…Few studies have evaluated the reproducibility of resting BP, HR and RPP in clinical populations 17,31,32 . This is surprising given the utility of these measures in guiding disease management and their positive relationship with cardiovascular morbidity and mortality 12,33 .…”