Prognostic impact of systolic blood pressure at admission on in-hospital outcome after primary percutaneous coronary intervention for acute myocardial infarction

Shiraishi, Jun; Kohno, Yoshio; Sawada, Takahisa; Hashimoto, Shingo; Ito, Daisuke; Kimura, Masayoshi; Matsui, Akihiro; Yokoi, Hiroyoshi; Arihara, Masayasu; Irie, Hidekazu; Hyogo, Masayuki; Shima, Takatomo; Nakamura, Takeshi; Matoba, Satoaki; Yamada, Hiroyuki; Matsumuro, Akiyoshi; Shirayama, Takeshi; Kikuchi, Makoto; Furukawa, Koichi; Matsubara, Hiroaki

doi:10.1016/j.jjcc.2012.02.008

Cited by 23 publications

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“…We have already shown that admission SBP or PP in a certain interval between an extremely low subset and extremely high subset might be associated with a lower in-hospital mortality in Japanese AMI patients undergoing primary percutaneous coronary intervention (PCI), which followed a J-or U-shaped curve pattern. 8,9) However, sufficient data regarding the effects of the steady component of blood pressure, MBP, at admission on the prognosis in AMI patients are still lacking. 10) The AMI-Kyoto Multi-Center Risk Study, a large multicenter observational study in which collaborating hospitals in Kyoto Prefecture have collected demographic, procedural, and outcome data on AMI patients, was established in 2000 in order to analyze this data and establish an emergency-hospital network for heart diseases in Kyoto.…”

Section: B Ased On Numerous Reports From Western Countries Anmentioning

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Relationship Between Mean Blood Pressure at Admission and In-Hospital Outcome After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

et al. 2016

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SummaryA J-shaped or U-shaped curve phenomenon might exist between systolic blood pressure (SBP) or pulse pressure (PP) at admission and in-hospital mortality in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). However, data regarding a relationship between mean blood pressure (MBP) at admission and in-hospital outcome in AMI patients undergoing primary PCI are still lacking in Japan.A total of 1,413 primary PCI-treated AMI patients were classified into quintiles based on admission MBP (< 79 n = 283, 79-91 n = 285, 92-103 n = 285, 104-115 n = 279, and ≥ 116 mmHg n = 281). Patients with MBP < 79 mmHg had a significantly higher in-hospital mortality, while mortality was not significantly different among the other quintiles: 16.6% (< 79), 4.9% (79-91), 3.9% (92-103), 3.2% (104-115), and 5.0% (≥ 116 mmHg). On multivariate analysis, Killip class ≥ 3 at admission, LMT or multivessels as culprit lesions, admission MBP < 79 mmHg, and age were independent positive predictors of in-hospital mortality, whereas hypercholesterolemia and TIMI 3 flow before/after PCI were negative predictors, while the other MBP categories were not.These results suggest that admission MBP < 79 mmHg might be associated with in-hospital death, and the in-hospital prognostic effects of MBP, the steady component of blood pressure, at admission might be different from those of SBP or PP, the pulsatile component of blood pressure, at admission in Japanese AMI patients undergoing primary PCI. (Int Heart J 2016; 57: 547-552) Key words: Systolic blood pressure, Pulse pressure, Prognosis, J-curve phenomenon B ased on numerous reports from Western countries, an inverse relationship between systolic blood pressure (SBP) at admission and in-hospital mortality in acute myocardial infarction (AMI) patients has largely been established, [1][2][3][4] and indeed admission SBP is involved in several riskscoring methods for AMI patients.5-7) In addition to major blood pressure indexes, such as SBP and diastolic blood pressure (DBP), blood pressure is characterized by its pulsatile and steady components, which correspond to pulse pressure (PP) and mean blood pressure (MBP), respectively. We have already shown that admission SBP or PP in a certain interval between an extremely low subset and extremely high subset might be associated with a lower in-hospital mortality in Japanese AMI patients undergoing primary percutaneous coronary intervention (PCI), which followed a J-or U-shaped curve pattern. 8,9) However, sufficient data regarding the effects of the steady component of blood pressure, MBP, at admission on the prognosis in AMI patients are still lacking.

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Section: B Ased On Numerous Reports From Western Countries Anmentioning

confidence: 99%

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confidence: 99%

Relationship Between Mean Blood Pressure at Admission and In-Hospital Outcome After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

et al. 2016

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“…However, a limited number of studies have evaluated the prognostic value of elevated admission SBP and have reported conflicting results. Some studies6 7 reported that the admission SBP was inversely associated with the outcome; while others8 9 reported admission SBP in a certain interval with optimal outcome.…”

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Clinical characteristics and short-term outcomes in patients with elevated admission systolic blood pressure after acute ST-elevation myocardial infarction: a population-based study

et al. 2014

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ObjectivePrognostic value of lower admission systolic blood pressure (SBP) in patients with acute myocardial infarction has been confirmed, but the impact of elevated admission SBP on short-term outcomes has been evaluated only by a limited number of studies and they have reported conflicting results. The aim of our study was to investigate the characteristics and short-term outcomes in patients with elevated admission SBP after ST-elevation myocardial infarction (STEMI).DesignA population-based, observational study.SettingThe multicentre registry in China.ParticipantsA total of 7510 consecutive patients with STEMI were registered. Patients were divided into three groups according to admission SBP: normal admission SBP (100–139 mm Hg), modestly elevated admission SBP (140–179 mm Hg) and excessively elevated admission SBP (≥180 mm Hg). The primary outcomes were 7-day and 30-day all-cause mortality, major adverse cardiac events (MACE) and bleeding rate.ResultsOf 6591 patients, 4182 (63.5%) had normal admission SBP, 2187 (33.2%) modestly elevated admission SBP and 222 (3.4%) excessively elevated admission SBP. Patients with elevated admission SBP had a high-risk profile, such as were more likely to be older, with more concomitant cardiovascular morbidities, presenting with more events of anterior myocardial infarction and less reperfusion treatment. However, 7-day and 30-day all-cause mortality, MACE and bleeding rate were comparable among groups (all p>0.05). Survival curves and MACE curves were similar among groups (p=0.377 and 0.375, respectively). After multivariate adjustment, elevated admission SBP was not associated with increased risk of short-term death and bleeding, and MACE was comparable with normal admission SBP.ConclusionsAlthough those with elevated admission SBP after STEMI were at a higher risk for cardiovascular events, they did not have poorer short-term outcomes compared with patients with normal admission SBP.

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“…10) network for heart diseases in Kyoto. 11) The purpose of the present study was therefore to examine the prognostic impact of admission CKD and admission anemia on PCI results and in-hospital outcomes in Japanese AMI patients undergoing primary PCI, using data from the AMI-Kyoto Multi-Center Risk Study.…”

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Prognostic Impact of Chronic Kidney Disease and Anemia at Admission on In-Hospital Outcomes After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

et al. 2014

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SummaryCardiorenal anemia syndrome has recently been receiving greater attention; however, data regarding the relationship between chronic kidney disease (CKD)/anemia on presentation and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still limited in Japan.A total of 1,447 primary PCI-treated AMI patients were classified into 4 groups according to the presence of CKD and/or anemia on hospital admission (with CKD/with anemia n = 222, with CKD/without anemia n = 299, without CKD/with anemia n = 151, without CKD/without anemia n = 775). Angiographic acute results of primary PCI were similar among the 4 groups. The patients with CKD had a significantly higher in-hospital overall mortality rate than the patients without CKD, and in the presence or absence of CKD, patients with anemia tended to have a higher in-hospital mortality rate than the patients without anemia. According to a multivariate analysis, anemia on admission was found to be an independent predictor of in-hospital mortality, whereas admission CKD and admission eGFR were statistically not independent predictors. Moreover, the multivariable adjusted odds ratio of in-hospital death in AMI patients with CKD alone was 1.855 (95% CI 0.929-3.706), and that in AMI patients with CKD/with anemia was 3.384 (95% CI 1.697-6.748).These results suggest that among real-world, unselected Japanese AMI patients undergoing primary PCI, the combination of CKD and anemia on admission confers significant adverse effects on in-hospital mortality. (Int Heart J 2014; 55: 301-306)

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Prognostic impact of systolic blood pressure at admission on in-hospital outcome after primary percutaneous coronary intervention for acute myocardial infarction

Abstract: These results suggest that admission SBP 141-158 mmHg might be correlated with better in-hospital prognosis, whereas admission SBP<105 mmHg was associated with in-hospital death in Japanese AMI patients undergoing primary PCI.

Cited by 23 publications

References 20 publications

Relationship Between Mean Blood Pressure at Admission and In-Hospital Outcome After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

Relationship Between Mean Blood Pressure at Admission and In-Hospital Outcome After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

Clinical characteristics and short-term outcomes in patients with elevated admission systolic blood pressure after acute ST-elevation myocardial infarction: a population-based study

Prognostic Impact of Chronic Kidney Disease and Anemia at Admission on In-Hospital Outcomes After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

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