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

Abstract

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.

Prediction Score Project for the Incidence of Cerebrovascular Events in Patients with Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…In the present study, BP at admission was divided into 5 groups and the risk coe cient increased with BP. Data on the relationship between BP at admission and long-term and shortterm outcomes in patients with acute MI who had undergone primary PCI have been well-documented [35,36], which is similar to the conclusion of the present study.…”

Pre-Procedural Thrombolysis in Myocardial Infarction Flow in Patients with ST-Segment Elevation Myocardial Infarction

“…Systolic blood pressure might increase because of myocardial reperfusion. 18) A complete atrioventricular block was more frequently administered in patients with pre-procedural TIMI flow grade 0-2 compared to those with grade 3 (5.03% versus 2.27%, P = 0.033), which may have been related to the higher heart rate in the TIMI flow grade 3 groups. Unlike our results, the independent predictors of pre-procedural TIMI flow grade 3 were diabetes, longer delay to PCI, smoking, and more extensive coronary disease in the CA-DILLAC and HORIZONS-AMI Trials.…”

A High Level of Blood Urea Nitrogen Is a Significant Predictor for In-hospital Mortality in Patients with Acute Myocardial Infarction

“…6) These models comprise several important predictors for worse cardiovascular outcomes in AMI patients: age, sex, angina, risk factors for coronary artery disease, signs of heart failure, systolic blood pressure, heart rate, cardiac arrest during presentation, ST-segment change, cardiac enzymes, and serum creatinine. [6][7][8][9][10]24) Creatinine is traditionally used as a marker of renal function, and reduced renal function is a known predictor for worse outcomes in ACS patients. 6) Estimated GFR, which is calculated by serum creatinine, is another marker of renal function.…”