Prognostic Significance of Presenting Blood Pressure in Patients With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Title
Prognostic Significance of Presenting Blood Pressure in Patients With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
Author(s)
김영조차광수[차광수]박진섭[박진섭]신동훈[신동훈]이대성[이대성]이혜원[이혜원]오준혁[오준혁]최정현[최정현]이한철[이한철]홍택종[홍택종]
Keywords
GLOBAL REGISTRY; HOSPITAL MORTALITY; HYPERTENSION; OUTCOMES; THERAPY; EVENTS; RISK; THROMBOLYSIS; MANAGEMENT; HISTORY
Issue Date
201506
Publisher
OXFORD UNIV PRESS
Citation
AMERICAN JOURNAL OF HYPERTENSION, v.28, no.6, pp.797 - 805
Abstract
BACKGROUND We evaluated the impact of normal vs. high presenting blood pressure (BP) on clinical outcomes and cardiac function in patients with ST-elevation myocardial infarction (MI). METHODS In 11,292 patients, in-hospital mortality and major adverse clinical events (MACE; all-cause death, nonfatal MI, or any revascularization) during follow-up were compared between patients with normal (>= 100 mm Hg and <= 139 mm Hg) and high (>= 140 mm Hg) systolic BP at presentation. RESULTS Compared to patients with high BP, patients with normal BP had significantly higher in-hospital mortality (1.5% vs. 3.7%; P < 0.001), especially in those with prior hypertension, and higher rates of all-cause death (3.3% vs. 5.3%; P < 0.001) and MACE (9.8% vs. 11.8%; P = 0.04) during follow-up (median: 330 days). After multivariate adjustment, normal BP was associated with higher risk of in-hospital mortality (adjusted hazard ratio (HR) = 2.268; 95% confidence interval (CI) = 1.144-4.498; P = 0.019), but not all-cause death (adjusted HR = 0.956; 95% CI = 0.602-1.517) or MACE (adjusted HR = 0.935; 95% CI = 0.755-1.158). Left ventricular ejection fraction at baseline and follow-up was significantly lower in patients with normal BP (52% vs. 51%; P < 0.001 and 55% vs. 54%; P = 0.018, respectively). CONCLUSIONS Our findings indicate that patients with normal presenting BP, especially those with prior hypertension, exhibit higher in-hospital mortality and poorer cardiac function compared to patients with high BP. Although outcomes during follow-up did not differ, cardiac function was persistently poorer in patients who presented with normal BP.
URI
http://hdl.handle.net/YU.REPOSITORY/32007http://dx.doi.org/10.1093/ajh/hpu230
ISSN
0895-7061
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의과대학 > 내과학교실 > Articles
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