Association Between Admission Blood Pressure and In-hospital Mortality and Long-term Mortality of Patients With
ZhiFeng Song1, Chilie Danzeng2, Yu Jiang1
1Center for Coronary Heart Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Insights
For ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), both low and high blood pressure (BP) increase mortality risk. The ideal BP for minimizing in-hospital death is 157/94 mmHg.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Acute myocardial infarction (AMI) is a leading global cause of death.
- Optimal blood pressure (BP) management for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) lacks clear guidelines.
- This variability creates uncertainty in clinical treatment strategies for STEMI patients receiving PCI.
Purpose of the Study:
- To identify ideal blood pressure (BP) levels associated with reduced in-hospital mortality and long-term adverse outcomes in STEMI patients undergoing PCI.
- To address the lack of specific BP management recommendations for STEMI patients undergoing PCI.
Main Methods:
- Retrospective analysis of 10,482 STEMI patients undergoing PCI from the China Acute Myocardial Infarction (CAMI) Registry.
- Primary outcome: in-hospital mortality. Secondary outcomes: 2-year all-cause mortality, severe bleeding, and major adverse cardiac and cerebrovascular events (MACCEs).
- Restricted cubic spline (RCS) analysis and Cox regression models were used to analyze the relationship between admission systolic blood pressure (SBP)/diastolic blood pressure (DBP) and outcomes.
Main Results:
- A J-shaped association was found between admission SBP/DBP and in-hospital mortality risk, indicating increased risk at both lower and higher BP levels.
- The optimal SBP/DBP for minimizing in-hospital mortality risk was identified as 157/94 mmHg.
- Lower admission SBP (<109 mmHg) or DBP (60-69 mmHg) significantly increased the risk of in-hospital mortality, severe bleeding, and MACCEs.
Conclusions:
- A J-curve relationship exists between admission BP and in-hospital mortality in STEMI patients undergoing PCI, with a nadir at 157/94 mmHg.
- Similar J-shaped trends were observed for all-cause mortality, severe bleeding, and MACCEs.
- No significant nonlinear correlation was found between admission BP and recurrent myocardial infarction within 2 years.
Background:
Globally, acute myocardial infarction (AMI) is among the primary causes of mortality. The ideal approach for blood pressure (BP) management for patients experiencing ST-segment elevation myocardial infarction (STEMI) who receive percutaneous coronary intervention (PCI) remains a topic of ongoing debate. Current guidelines on BP management lack specific recommendations for STEMI patients undergoing PCI, resulting in substantial individual variability and uncertainties in clinical treatment strategies. This research seeks to determine the ideal BP levels linked to the lowest risk of in-hospital mortality and long-term adverse endpoints in STEMI patients receiving PCI.
Methods:
This retrospective study analyzed data from the China Acute Myocardial Infarction (CAMI) Registry, enrolling 10,482 STEMI patients undergoing PCI at 108 Chinese hospitals from January 2013 to September 2014. The primary outcome was in-hospital mortality. Secondary outcomes included 2-year all-cause mortality, severe bleeding, and major adverse cardiac and cerebrovascular events (MACCEs), defined as a combination of all-cause mortality, myocardial infarction (MI), or stroke. The analysis of the relationship between admission systolic blood pressure (SBP)/diastolic blood pressure (DBP) and the primary and secondary outcomes as continuous and categorical variables was conducted using restricted cubic spline (RCS) analysis and Cox regression models.
Results:
RCS analysis revealed that a J-shaped association existed between admission SBP/DBP and the risk of the primary outcome, with significant nonlinearity (both p < 0.001). Both lower and higher SBP/DBP levels were linked to an elevated risk of in-hospital mortality. The ideal SBP/DBP levels to minimize the in-hospital mortality risk were 157/94 mmHg. Compared to the reference SBP/DBP group (120-129/70-79 mmHg), lower admission SBP (<109 mmHg) or DBP (60-69 mmHg) significantly elevated the risk of the primary outcome. The adjusted hazard ratio (HR) for SBP levels of 100-109 mmHg and <100 mmHg was 1.08 (95% confidence interval (CI): 1.00-1.17; p = 0.0395 and p = 0.043, respectively), and for DBP of 60-69 mmHg, the adjusted HR was 1.07 (95% CI: 1.01-1.14, p = 0.0305). Similarly, the J-shaped curve was also noted between SBP/DBP and secondary outcomes, such as all-cause mortality, severe bleeding and MACCEs. However, no significant non-linear relationship was observed between SBP/DBP and recurrent MI at 2-year follow-up.
Conclusions:
Among STEMI patients undergoing PCI, a J-curve relationship in in-hospital mortality was observed with a nadir at 157/94 mmHg. Similar J-shaped trends were also observed for secondary outcomes including all-cause mortality, severe bleeding and MACCEs. However, no significant nonlinear correlation was found between admission BP and recurrent MI within 2 years.
Clinical Trial Registration:
NCT01874691, https://www.clinicaltrials.gov/study/NCT01874691?term=NCT01874691&rank=1.
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