Age-Dependent Associations Between Pulse Pressure and Long-Term Outcomes After Myocardial Infarction

Pulse pressure (PP) is a recognized marker of cardiovascular risk in the general population. However, its role as an independent predictor of recurrent cardiovascular events following myocardial infarction (MI) and whether there are age-dependent differences in this relationship remains uncertain. We analyzed data from 4091 participants with a history of MI were enrolled in the Kailuan Study. Univariate and multivariable Cox models were used to analyze the associations between PP and primary outcome (composite cardiovascular events, a composite of all-cause death, nonfatal recurrent MI, nonfatal hospitalization for heart failure or nonfatal stroke) and secondary outcomes (each individual components of composite endpoint) after MI. Over a median follow-up of 7.8 years, 1610 composite cardiovascular events occurred. The mean baseline PP was 54.2 ± 16.1 mmHg. Compared with individuals in the first PP quartile, those in the fourth quartile had significantly greater risks of composite cardiovascular events (adjusted HR: 1.20; 95% CI: 1.03-1.41; p = 0.02) and recurrent MI (adjusted HR: 1.56; 95% CI: 1.03-2.36; p = 0.04). A linear, dose-response relationship was observed between PP and the risk of adverse cardiovascular outcomes (all p ≤ 0.02), except for stroke (p = 0.36). Subgroup analyses indicated that the association between PP and adverse outcomes was stronger among participants aged <60 years compared with older individuals. Elevated PP is an independent predictor of recurrent cardiovascular outcomes in post-MI patients, with particularly stronger associations observed in younger and middle-aged adults. Trial Registration: ChiCTR-TNRC-11001489.