The U‐shape relationship between pulse pressure level on inpatient admission and long‐term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention

Huang, Wei; Li, Hongwei; Ying, Sun; Zhang, Dai; Wang, Man

doi:10.1111/jch.14408

Cited by 3 publications

(1 citation statement)

References 45 publications

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“…Although emergency percutaneous coronary intervention (PCI) is the most effective way to save the ischemic myocardium, there are many prognostic factors, including preoperative blood pressure, vascular patency time, underlying diseases, age, hypertension, diabetes, and criminal vessels. It is generally believed that brachial systolic and diastolic blood pressures have a "J" or "U"shaped relationship with mortality in patients with acute coronary syndrome (1)(2)(3)(4). However, there are few studies on the relationship between central arterial pressure (CAP) and outcomes after PCI, and there is no generally accepted reference range and diagnostic threshold (5).…”

Section: Introductionmentioning

confidence: 99%

Central arterial pressure predicts in-hospital major adverse cardiovascular events after acute ST-segment elevation myocardial infarction: a retrospective cohort study

Zhang¹,

Wang²,

Lu³

et al. 2023

Ann Transl Med

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Background Percutaneous coronary intervention (PCI) is currently the main treatment of acute ST-segment elevated myocardial infarction (STEMI), whereafter various postoperative adverse events often occur. Central arterial pressure (CAP) is closely related to the pathophysiological process of cardiovascular disease, and its relationship with outcomes after PCI in STEMI patients remains unclear. The aim of this study was to observe the relationship between pre-PCI CAP and in-hospital outcomes in STEMI patients which might be helpful to evaluate prognosis. Methods A total of 512 STEMI patients who underwent emergency PCI were included. Baseline data and CAP information before PCI and in-hospital outcomes were collected. Multivariate logistic regression was used to adjust for confounding factors. Potential non-linear relationships between CAP and in-hospital outcomes were described using a restricted cubic bar plot. The area under the receiver operating characteristic (ROC) curve (AUC), net reclassification index, and composite discriminant improvement index were used to analyze the correlation between CAP and outcomes during hospitalization. Results Among the 512 patients, 116 experienced at least 1 in-hospital major adverse cardiovascular events (MACEs), with an incidence rate of 22.60%. Among CAP indicators, higher [>137.5 mmHg, OR =2.70, 95% confidence interval (CI): 1.20–6.06] or lower (<102 mmHg, OR =7.55, 95% CI: 3.45–16.52) central systolic pressure (CSP), lower (<61 mmHg, OR =2.78, 95% CI: 1.36–5.67) central diastolic pressure (CDP), higher (>55 mmHg, OR =2.09, 95% CI: 1.01–4.31) or lower (<29 mmHg, OR =3.28, 95% CI: 1.54–7.00) central pulse pressure (CPP), and higher (>101 mmHg, OR =2.07, 95% CI: 1.01–4.61) or lower (<76 mmHg, OR =4.91, 95% CI: 2.31–10.44) central mean pressure (CMP) were independent risk factors for MACEs. The relationship between CSP and CMP and in-hospital outcomes showed a “J”-shaped relationship, CDP and in-hospital outcomes showed an “L”-shaped relationship, and CPP and in-hospital outcomes showed a “U”-shaped relationship. There was no statistical difference in the prediction ability of in-hospital outcomes detected between CSP, CDP, and CMP (P>0.05), but the comparison of the 3 with CPP was statistically significant (P<0.05). Conclusions CSP, CDP, and CMP have certain predictive ability for postoperative in-hospital outcomes in STEMI patients and can be used during percutaneous intervention.

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Section: Introductionmentioning

confidence: 99%

Central arterial pressure predicts in-hospital major adverse cardiovascular events after acute ST-segment elevation myocardial infarction: a retrospective cohort study

Zhang¹,

Wang²,

Lu³

et al. 2023

Ann Transl Med

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The U‐shape relationship between pulse pressure level on inpatient admission and long‐term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention

Huang

Ying

et al. 2021

J of Clinical Hypertension

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The association between pulse pressure and long‐term mortality was investigated among acute coronary syndrome (ACS) patients who received percutaneous coronary intervention (PCI). The study population included 5055 ACS patients in the Department of Cardiology of Beijing Friendship Hospital who were enrolled from January 2013 to July 2019. The median duration of follow‐up was 24 months. Multivariate Cox regression was used to analyze the relationships between PP on inpatient admission and mortalities. Non‐linear associations were studied by restricted cubic splines. Considering the heart function, the analyses were performed in the whole cohort and the LVEF > = 0.5 cohort separately. Subgroup analyses were performed according to the different diagnosis (the myocardial infarction subgroup and the unstable angina pectoris subgroup). When PP was used as categorical variable, the high PP group (≥61 mm Hg) significantly increased the risk of death compared with the intermediate PP group (50–60 mm Hg) in the both cohorts. When PP was used as continuous variable, a U‐shape relationship were found between PP and mortalities in the whole cohort ( p (for nonlinearity) = .005 and .003, respectively), with reference PP level of 55 mm Hg. However, this U‐shape relationship disappeared in the LVEF > 0.5 cohort ( p (for nonlinearity) = .111 and .117, respectively). The similar results were obtained in MI subgroup. From this study, the U‐shape relationships between PP level and all‐cause and cardiac mortalities were found in ACS patients who underwent PCI. The U‐shape relationships disappeared in the LVEF > 0.5 cohort. The reference PP level was 55 mm Hg.

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Pulse Pressure Independent of Mean Arterial Pressure Is Associated with Cardiovascular and All-Cause Mortality in Normotensive Elders: Findings from National Health and Nutrition Examination Survey III 1999–2014

Jiang

Zhang

et al. 2022

JVD

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Background: Pulse pressure (PP), a marker of arterial stiffening, is closely related to adverse outcomes in hypertensive patients. Correspondingly, less attention has been paid to the value of PP in the population with normal blood pressure. Methods: The study included normotensive elders aged over 60 years from the 1999–2014 National Health and Nutrition Examination Survey (NHANES). All included participants were followed up until the date of death or 31 December 2015. Restricted cubic spline analyses were used to explore the associations of PP with cardiovascular mortality and all-cause mortality. The population was categorized into two groups according to the optimal cut-off of PP for all-cause mortality by X-tile software. Propensity matching score analysis was further performed to reduce confounding bias. The Kaplan–Meier curves and Cox proportional hazard models were applied to estimate the associations of widening PP cardiovascular mortality and all-cause mortality. Subgroup analyses were also conducted. Results: A total of 6309 participants were included (52.9% men and median age 69 (63, 75) years). The median follow-up duration was 74 (42, 114) months. The restricted cubic spline analyses revealed that continuous PP was linearly related to cardiovascular mortality (p for linearity < 0.001; p for nonlinearity = 0.284) and nonlinearly related to all-cause mortality (p for nonlinearity = 0.001). After propensity score matching, 1855 subjects with widening PP and 1855 matched counterparts were included (50.2% men and average age 72 (66, 78) years, 50.9% men and average age 72 (66, 78) years, respectively), of which 966 (26.0%) died during a median follow-up duration of 71 (39, 105) months. In the Cox proportional hazards model, widening PP was associated with increased cardiovascular mortality Hazard Ratio (HR) 1.47; 95% Confidence Interval (CI) 1.07–2.00, p < 0.05] and all-cause mortality (HR 1.15; 95% CI 1.01–1.31, p < 0.05). After adjusting for other traditional risk factors, the association of widening PP with cardiovascular mortality (HR 1.44; 95%CI 1.05–1.98, p < 0.05) remained, and the association of widening PP with all-cause mortality was not statistically significant (p > 0.05). Conclusion: In the normotensive elder population, a low-risk population without traditional coronary risk factors, PP is an independent risk factor for cardiovascular mortality.

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The U‐shape relationship between pulse pressure level on inpatient admission and long‐term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention

Cited by 3 publications

References 45 publications

Central arterial pressure predicts in-hospital major adverse cardiovascular events after acute ST-segment elevation myocardial infarction: a retrospective cohort study

Central arterial pressure predicts in-hospital major adverse cardiovascular events after acute ST-segment elevation myocardial infarction: a retrospective cohort study

The U‐shape relationship between pulse pressure level on inpatient admission and long‐term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention

Pulse Pressure Independent of Mean Arterial Pressure Is Associated with Cardiovascular and All-Cause Mortality in Normotensive Elders: Findings from National Health and Nutrition Examination Survey III 1999–2014

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