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Effect of inter-arm blood pressure differences on outcomes after percutaneous coronary intervention
Se-Jun Park1, Jung-Woo Son2, Kyung-Soon Hong3
1Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
Insights
Inter-arm blood pressure differences (IABPD) impact outcomes after percutaneous coronary intervention (PCI). Higher IABPD is linked to increased major adverse cardiac events (MACE), primarily due to target vessel revascularization.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Percutaneous coronary intervention (PCI) is a common revascularization strategy for CAD.
- Inter-arm blood pressure difference (IABPD) may indicate underlying vascular dysfunction.
Purpose of the Study:
- To investigate the association between IABPD and clinical outcomes in patients undergoing PCI.
- To determine if IABPD is an independent predictor of major adverse cardiac events (MACE) after PCI.
Main Methods:
- Retrospective analysis of 855 patients who underwent PCI with drug-eluting stents for CAD.
- IABPD defined as the difference in blood pressure between bilateral arms.
- Primary outcome: MACE (cardiovascular death, myocardial infarction, stroke, ischemia-driven target vessel revascularization).
Main Results:
- Higher IABPD (≥10 mmHg) was associated with a trend towards increased MACE (22.5% vs 14.5%, p=0.081).
- Ischemia-driven target vessel revascularization was significantly higher in the higher IABPD group (17.5% vs 8.3%, p=0.011).
- IABPD was identified as an independent predictor of long-term MACE (HR 1.028, p=0.037).
Conclusions:
- Elevated IABPD is associated with a higher incidence of MACE after PCI for CAD.
- The increased MACE risk in patients with higher IABPD is primarily driven by ischemia-driven target vessel revascularization.
- IABPD serves as a valuable independent predictor for long-term adverse outcomes following PCI.
Background:
We investigated the effect of inter-arm blood pressure differences (IABPD) on the percutaneous coronary intervention (PCI) outcomes of patients with coronary artery diseases.
Methods:
We retrospectively reviewed the data of blood pressures measured simultaneously in the bilateral arms of 855 patients (560 males) who underwent PCI with drug-eluting stents for coronary artery diseases. IABPD was defined as the difference of blood pressure in both arms. The primary outcome was the presence of major adverse cardiac events (MACE) consisting of cardiovascular death, myocardial infarction, stroke, and ischemia-driven target vessel revascularization.
Results:
The mean age of the included patients was 66.2 ± 11.6 years, with a mean follow-up period of 44.5 ± 26.4 months. MACE occurred in 15.2% of patients, showing a higher rate in the higher IABPD group (≥10 mmHg) than in the lower IABPD group (<10 mmHg) (22.5% vs 14.5%, p = 0.081). The difference was induced by a higher rate of ischemia-driven target vessel revascularization (17.5% vs 8.3%, p = 0.011). The Kaplan-Meier survival analysis revealed a greater incidence of MACE in patients with a higher IABPD (log rank p = 0.054). The Cox proportional hazard analysis showed that IABPD was an independent predictor of long-term MACE (hazard ratio, 1.028; 95% confidence interval, 1.002-1.055; p = 0.037), along with age, diabetes mellitus, and number of implanted stents.
Conclusion:
Among patients treated with PCI, the incidence of MACE was significantly higher in those with a higher IABPD (≥10 mmHg) than in those with a lower IABPD (<10 mmHg), which was mainly driven by ischemia-driven target vessel revascularization.
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