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Association of Blood Pressure Variability with Contrast Nephropathy in STEMI Patients Undergoing Primary PCI
Cahit Coskun1, Semih Eren2, Feyza Mollaalioglu2
1Ministry of Health Demirci State Hospital, Cardiology Dr. Mehmet Akarsu Street Demirci, Manisa.
Insights
Blood pressure variability (BPV) is linked to contrast-induced nephropathy (CIN) in ST-elevation myocardial infarction (STEMI) patients. High systolic BPV, specifically systolic standard deviation and average real variability, independently predicts CIN development after PCI.
Area of Science:
- Cardiology
- Nephrology
- Clinical Physiology
Background:
- ST-segment elevation myocardial infarction (STEMI) remains a leading cause of death globally.
- Contrast-induced nephropathy (CIN) complicates percutaneous coronary intervention (PCI) in STEMI patients, increasing morbidity and mortality.
- Blood pressure variability (BPV) is linked to adverse cardiovascular outcomes and renal dysfunction, but its association with CIN is unknown.
Purpose of the Study:
- To investigate the relationship between short-term, invasively measured BPV and CIN in STEMI patients undergoing PCI.
- To identify specific BPV parameters that predict CIN development.
Main Methods:
- Prospective study of 220 hemodynamically stable STEMI patients undergoing PCI.
- Invasive blood pressure monitoring via femoral sheath for six hours post-PCI.
- Calculation of systolic and diastolic standard deviation (SD) and average real variability (ARV) using universal formulae.
Main Results:
- A significant association was found between short-term BPV and CIN development (p < 0.01).
- Systolic BPV parameters, specifically systolic SD (OR: 1.055, p=0.04) and systolic ARV (OR: 1.084, p=0.02), were identified as independent predictors of CIN.
Conclusions:
- Intra-arterially measured short-term BPV is associated with CIN development in STEMI patients.
- Systolic SD and systolic ARV are independent predictors of CIN, potentially aiding early diagnosis and prevention.
- Further large-scale trials are needed to confirm BPV as a clinical indicator of CIN risk.
Background:
Cardiovascular disease, particularly ST-segment elevation myocardial infarction (STEMI), continues to be a leading cause of death worldwide despite advances in treatment options. Contrast-induced nephropathy (CIN) increases the risk of morbidity and mortality after percutaneous coronary intervention (PCI) in STEMI patients. Blood pressure variability (BPV), defined as fluctuations in blood pressure (BP) over time, has been associated with cardiovascular events, stroke, target organ damage and renal dysfunction independently of BP levels. The relationship between BPV and CIN is unknown.
Methods:
This prospective study investigated the relationship between invasively measured short-term BPV and CIN in haemodynamically stable STEMI patients undergoing PCI. In 220 patients, BP was monitored through the femoral sheath for six hours after PCI, and systolic and diastolic standard deviation (SD), average real variability (ARV) and delta parameters were calculated using universal formulae.
Results:
The results indicated a significant association between short-term BPV, especially systolic BPV, and the development of CIN (p < 0.01). In particular, systolic SD [odds ratio (OR): 1.055, 95% confidence interval (CI) 1.003-1.110, p = 0.04] and systolic ARV (OR: 1.084, 95% CI 1.011-1.162, p = 0,02) emerged as independent predictors of CIN.
Conclusions:
Our study demonstrated that intra-arterially measured short-term BPV was associated with the development of CIN in STEMI patients. Notably, systolic SD and systolic ARV were independent predictors of CIN, which may be of clinical importance for early diagnosis and prevention. These results suggest that BPV may be an indicator of CIN risk, and further large-scale randomised trials are warranted to clarify this relationship.
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