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Relationship Between Mean Blood Pressure at Admission and In-Hospital Outcome After Primary Percutaneous Coronary
Jun Shiraishi1, Takeshi Nakamura, Akira Shikuma
1Department of Cardiology, Kyoto First Red Cross Hospital.
Insights
Low mean blood pressure (MBP) on admission, specifically below 79 mmHg, is linked to higher in-hospital mortality in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Other MBP levels did not show significant differences in mortality outcomes.
Area of Science:
- Cardiology
- Clinical Research
- Hemodynamics
Background:
- The relationship between admission blood pressure parameters and in-hospital mortality in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI) is crucial for risk stratification.
- While J-shaped or U-shaped curves have been observed for systolic blood pressure (SBP) and pulse pressure (PP), the prognostic significance of mean blood pressure (MBP) in this specific patient population in Japan remains understudied.
Purpose of the Study:
- To investigate the association between admission mean blood pressure (MBP) and in-hospital mortality in Japanese patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).
- To determine if a specific MBP threshold predicts adverse outcomes in this cohort.
Main Methods:
- A retrospective analysis of 1,413 Japanese patients with AMI undergoing primary PCI.
- Patients were categorized into quintiles based on admission MBP: < 79 mmHg, 79-91 mmHg, 92-103 mmHg, 104-115 mmHg, and ≥ 116 mmHg.
- In-hospital mortality rates were compared across these quintiles, and multivariate analysis was performed to identify independent predictors of mortality.
Main Results:
- Patients with admission MBP < 79 mmHg exhibited significantly higher in-hospital mortality (16.6%) compared to other groups.
- Mortality rates were not significantly different among patients with MBP ≥ 79 mmHg (ranging from 3.2% to 5.0%).
- Multivariate analysis identified admission MBP < 79 mmHg, Killip class ≥ 3, left main or multivessel culprit lesions, and advanced age as independent predictors of in-hospital mortality.
Conclusions:
- Admission mean blood pressure (MBP) below 79 mmHg is associated with an increased risk of in-hospital death in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI).
- The prognostic impact of MBP, a steady blood pressure component, may differ from that of pulsatile components like SBP or PP in this clinical setting.
- These findings highlight the importance of monitoring MBP for risk stratification and management of AMI patients undergoing primary PCI.
Abstract:
A J-shaped or U-shaped curve phenomenon might exist between systolic blood pressure (SBP) or pulse pressure (PP) at admission and in-hospital mortality in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). However, data regarding a relationship between mean blood pressure (MBP) at admission and in-hospital outcome in AMI patients undergoing primary PCI are still lacking in Japan.A total of 1,413 primary PCI-treated AMI patients were classified into quintiles based on admission MBP (< 79 n = 283, 79-91 n = 285, 92-103 n = 285, 104-115 n = 279, and ≥ 116 mmHg n = 281). Patients with MBP < 79 mmHg had a significantly higher in-hospital mortality, while mortality was not significantly different among the other quintiles: 16.6% (< 79), 4.9% (79-91), 3.9% (92-103), 3.2% (104-115), and 5.0% (≥ 116 mmHg). On multivariate analysis, Killip class ≥ 3 at admission, LMT or multivessels as culprit lesions, admission MBP < 79 mmHg, and age were independent positive predictors of in-hospital mortality, whereas hypercholesterolemia and TIMI 3 flow before/after PCI were negative predictors, while the other MBP categories were not.These results suggest that admission MBP < 79 mmHg might be associated with in-hospital death, and the in-hospital prognostic effects of MBP, the steady component of blood pressure, at admission might be different from those of SBP or PP, the pulsatile component of blood pressure, at admission in Japanese AMI patients undergoing primary PCI.
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Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.