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Published on: February 5, 2021
Association between DBP and major adverse cardiovascular events in patients with ST-segment elevation myocardial
Yuan-Hui Liu1, Yi-Ning Dai1, Li-Tao Wang1
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou.
Insights
Low diastolic blood pressure (DBP) increases risks for patients after myocardial infarction. This study found that lower DBP independently predicts higher risks of in-hospital major adverse cardiovascular events and death.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Low diastolic blood pressure (DBP) is linked to increased risks in stable coronary artery disease.
- The association between low DBP and outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) remains unclear.
Purpose of the Study:
- To investigate the relationship between admission DBP and in-hospital major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI.
- To assess the association of DBP with all-cause death during follow-up.
Main Methods:
- A cohort of 2198 STEMI patients undergoing PCI between January 2010 and June 2016 were analyzed.
- Patients were stratified into five groups based on admission DBP quintiles.
- In-hospital MACE (all-cause death, stroke, target vessel revascularization, recurrent MI) and follow-up all-cause death were primary outcomes.
Main Results:
- A total of 157 patients (7.1%) experienced in-hospital MACE.
- Patients with DBP < 60 mmHg had significantly higher rates of in-hospital MACE (14.8%) and all-cause death (12.5%) compared to higher DBP groups.
- Multivariate analysis revealed DBP > 90 mmHg as a predictor of lower MACE risk (OR=0.16), and lower DBP was independently associated with increased all-cause death during follow-up.
Conclusions:
- Low diastolic blood pressure is independently associated with an elevated risk of in-hospital MACE in STEMI patients undergoing PCI.
- Lower DBP also predicts a higher risk of all-cause death during the follow-up period.
Background:
In patients with stable coronary artery disease, low DBP is associated with an increased risk of myocardial infarction and cardiovascular death, but its association with clinical outcomes in patients with acute myocardial infarction undergoing percutaneous coronary intervention (PCI) is unknown.
Methods:
Consecutive patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI from January 2010 to June 2016 were enrolled. The patients were divided into five groups according to the quintiles of DBP at admission. The primary outcome was in-hospital major adverse cardiovascular events (MACE) including all-cause death, stroke, target vessel revascularization, and recurrent myocardial infarction.
Results:
A total of 2198 patients were enrolled, of whom 157 (7.1%) developed in-hospital MACE. Patients with DBP lower than 60 mmHg was associated with a higher rate of in-hospital MACE (14.8, 7.8, 5.6, 6.1, and 3.8%, P < 0.001) and all-cause death (12.5, 6.4, 4.3, 3.9, and 1.9%, P < 0.001) compared with those with DBP 60-69, 70-79, 80-89, and at least 90 mmHg. Multivariate logistic regression analysis demonstrated that DBP higher than 90 mmHg was a significant predictor of lower risk of in-hospital MACE (OR = 0.16, 95% CI = 0.04-0.61, P = 0.007). Cubic spline models for the association between DBP and MACE did not demonstrate a U-type relationship after adjusting for potential risk factors. During the follow-up, lower DBP was associated with a higher risk of all-cause death (P < 0.0001).
Conclusion:
Lower DBP is independently associated with an elevated risk of in-hospital MACE and follow-up all-cause death.
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