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

Josephine Warren, Shane Nanayakkara, Nick Andrianopoulos, Angela Brennan, Diem Dinh, Matias Yudi, David Clark, Andrew E. Ajani, Laura Selkrig, James Shaw, Chin Hiew, Melanie Freeman, David Kaye, Bronwyn A. Kingwell, Anthony M. Dart, Stephen J. Duffy, on behalf of the Melbourne Interventional Group (MIG)

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Abstract

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.

Original languageEnglish
Pages (from-to)2846-2855
Number of pages10
JournalJournal of the American College of Cardiology
Volume73
Issue number22
DOIs
Publication statusPublished - 11 Jun 2019

Keywords

  • blood pressure
  • coronary artery disease
  • outcomes
  • percutaneous coronary intervention
  • pulse pressure

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