The clinical course of acute ST-elevation myocardial infarction in patients with hypertension
Magdalena Rembek1, Aleksander Goch, Jan Goch
1Department of Cardiology, Medical University, Lodz, Poland.
Insights
Hypertension in acute ST-elevation myocardial infarction (STEMI) patients is linked to more cardiovascular risks and a complicated hospital course. However, in-hospital deaths were similar between hypertensive and normotensive STEMI patients.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Arterial hypertension is a significant cardiovascular risk factor.
- Previous studies on hypertension's impact on acute ST-elevation myocardial infarction (STEMI) prognosis yielded inconsistent results.
- Understanding hypertension's role in STEMI is crucial for patient management.
Purpose of the Study:
- To compare the clinical course and short-term prognosis of STEMI patients with and without a history of hypertension.
- To identify differences in cardiovascular risk factors and in-hospital complications between these two groups.
Main Methods:
- A study group of 366 STEMI patients was analyzed.
- Patients were divided into two groups: those with (n=234) and without (n=132) a history of hypertension.
- All patients underwent primary angioplasty with stent implantation; medical history, risk factors, clinical course, and complications were compared.
Main Results:
- Hypertensive STEMI patients exhibited a higher prevalence of coronary artery disease, obesity (BMI>25 kg/m2), type 2 diabetes, hyperlipidemia, and renal disease.
- Patients with hypertension experienced more complicated clinical courses, including higher rates of cardiogenic shock, pulmonary edema, sinus tachycardia, ventricular tachycardia/fibrillation, and complete atrioventricular block.
- In-hospital mortality rates were not significantly different between the groups (7.7% vs. 5.3%). Multivariate analysis identified distinct independent prognostic factors for adverse outcomes in each group.
Conclusions:
- STEMI patients with hypertension present with a greater burden of cardiovascular risk factors.
- Hypertension is associated with a more complicated in-hospital course following STEMI.
- While complications are more frequent, in-hospital mortality may not differ significantly, highlighting the need for tailored risk stratification.
Background:
Arterial hypertension has been documented as one the cardiovascular risk factors. The issue whether hypertension worsens the clinical course and short-term prognosis of patients with acute ST-elevation myocardial infarction (STEMI) has been addressed by several studies, however, the results were not uniform.
Aim:
To compare the clinical course and short-term prognosis in STEMI patients with or without hypertension.
Methods:
The study group consisted of 366 patients with STEMI, of whom 234 (63.9%) had a history of hypertension (150 males, mean age 58.5+/-11.2 years) whereas 132 (100 males, mean age 60.3+/-11.9) did not. All patients underwent primary angioplasty with stent implantation. Details from medical history, cardiovascular risk factors, clinical course and in-hospital complications were recorded and compared between patients with and without hypertension.
Results:
There were differences between both study groups in the prevalence of cardiovascular risk factors. Patients with hypertension had more frequently history of coronary artery disease (56 vs. 37%, p<0.01), BMI>25 kg/m2 (90 vs. 85%, p<0.01), type 2 diabetes (27 vs. 14%, p<0.05), hyperlipidaemia (56 vs. 43%, p<0.05), and renal disease (11 vs. 5%, p<0.05). Clinical course of MI was more complicated in patients with hypertension who had more often cardiogenic shock (10 vs. 6%, p<0.05), pulmonary oedema (12 vs. 4%, p<0.05), sinus tachycardia>90 beats/min on admission (12 vs. 4%, p<0.05), ventricular tachycardia or fibrillation (20 vs. 11%, p<0.01) and complete atrioventricular block (11 vs. 4%, p<0.01). In-hospital deaths occurred in 18 (7.7%) patients with hypertension and 7 (5.3%) patients without hypertension (NS). Multivariate analysis identified age>65 years, symptoms of heart failure, atrial fibrillation, elevated blood glucose level and creatinine level as independent prognostic factors of adverse outcome in both groups whereas history of stroke, increased while cell blood count, urea level and two-vessel disease where independent prognostic variables in patients with hypertension. Ventricular tachycardia or fibrillation had prognostic significance only in STEMI patients without hypertension.
Conclusion:
Patients with STEMI and hypertension have more cardiovascular risk factors and more complicated in-hospital course of MI than normotensive patients.
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