Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:73

Article

Warren, Josephine¹  Nanayakkara, Shane^1,2,3  Andrianopoulos, Nick⁴  Brennan, Angela⁴  Dinh, Diem⁴  Yudi, Matias⁵  Clark, David⁵  Ajani, Andrew E.⁶  Reid, Christopher M.⁴  Selkrig, Laura¹  Shaw, James¹  Hiew, Chin⁷  Freeman, Melanie⁸  Kaye, David^1,2,3  Kingwell, Bronwyn A.²  Dart, Anthony M.^1,2  Duffy, Stephen J.^1,2,4 

[1] Alfred Hosp, Melbourne, Vic, Australia

[2] Baker Heart & Diabet Inst, Melbourne, Vic, Australia

[3] Monash Univ, Dept Med Nursing & Hlth Sci, Melbourne, Vic, Australia

[4] Monash Univ, Ctr Cardiovasc Res & Educ Therapeut, Melbourne, Vic, Australia

[5] Austin Hosp, Melbourne, Vic, Australia

[6] Royal Melbourne Hosp, Melbourne, Vic, Australia

[7] Geelong Hosp, Geelong, Vic, Australia

[8] Box Hill Hosp, Melbourne, Vic, Australia

关键词: blood pressure;    coronary artery disease;    outcomes;    percutaneous coronary intervention;    pulse pressure;   

DOI  :  10.1016/j.jacc.2019.03.493

来源: Elsevier

【 摘 要 】

BACKGROUND High systolic blood pressure (SBP) increases cardiac afterload, whereas low diastolic blood pressure (DBP) may lead to impaired coronary perfusion. Thus, wide pulse pressure (high systolic, low diastolic [HSLD]) may contribute to myocardial ischemia and also be a predictor of adverse cardiovascular events. OBJECTIVES The purpose of this study was to determine the relationship between pre-procedural blood pressure and long-term outcome following percutaneous coronary intervention (PCI). METHODS The study included 10,876 consecutive patients between August 2009 and December 2016 from the Melbourne Interventional Group registry undergoing PCI with pre-procedural blood pressure recorded. Patients with ST-segment elevation myocardial infarction, cardiogenic shock, and out-of-hospital cardiac arrest were excluded. Patients were divided into 4 groups according to SBP (high >= 120 mm Hg, low <120 mm Hg) and DBP (high >70 mm Hg, low <= 70 mm Hg). RESULTS Mean pulse pressure was 60 +/- 21 mm Hg. Patients with HSLD were older and more frequently women, with higher rates of hypercholesterolemia, renal impairment, diabetes, and multivessel and left main disease (all p <= 0.0001). There was no difference in 30-day major adverse cardiac events, but at 12 months the HSLD group had a greater incidence of myocardial infarction (p = 0.018) and stroke (p = 0.013). Long-term mortality was highest for HSLD (7.9%) and lowest for low systolic, high diastolic (narrow pulse pressure) at 2.1% (p = 0.0002). Cox regression analysis demonstrated significantly lower long-term mortality in the low systolic, high diastolic cohort (hazard ratio: 0.50; 99% confidence interval: 0.25 to 0.98; p = 0.04). CONCLUSIONS Pulse pressure at the time of index PCI is associated with long-term outcomes following PCI. A wide pulse pressure may serve as a surrogate marker for risk following PCI and represents a potential target for future therapies. (C) 2019 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

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