TY - JOUR
T1 - Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention
AU - Warren, Josephine
AU - Nanayakkara, Shane
AU - Andrianopoulos, Nick
AU - Brennan, Angela
AU - Dinh, Diem
AU - Yudi, Matias
AU - Clark, David
AU - Ajani, Andrew E.
AU - Selkrig, Laura
AU - Shaw, James
AU - Hiew, Chin
AU - Freeman, Melanie
AU - Kaye, David
AU - Kingwell, Bronwyn A.
AU - Dart, Anthony M.
AU - Duffy, Stephen J.
AU - on behalf of the Melbourne Interventional Group (MIG)
PY - 2019/6/11
Y1 - 2019/6/11
N2 - 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.
AB - 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.
KW - blood pressure
KW - coronary artery disease
KW - outcomes
KW - percutaneous coronary intervention
KW - pulse pressure
UR - http://www.scopus.com/inward/record.url?scp=85066095790&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2019.03.493
DO - 10.1016/j.jacc.2019.03.493
M3 - Article
C2 - 31171090
AN - SCOPUS:85066095790
SN - 0735-1097
VL - 73
SP - 2846
EP - 2855
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 22
ER -