Subgroup-specific correlation between systolic blood pressure and mortality in patients with coronary artery disease...

Area of Science:

• Cardiology
• Clinical Research
• Public Health

Background:

• Blood pressure (BP) management is critical in patients with coronary artery disease (CAD).
• The optimal systolic blood pressure (SBP) threshold for mortality risk may differ based on patient comorbidities.
• Percutaneous coronary intervention (PCI) is a common procedure for CAD, necessitating understanding of post-procedural BP targets.

Purpose of the Study:

• To investigate the subgroup-specific association between SBP and mortality risk in patients undergoing PCI.
• To identify the SBP levels that minimize mortality risk across different patient strata.
• To inform personalized BP management strategies for multimorbid CAD patients.

Main Methods:

• Retrospective analysis of a nationwide multicenter database (CLIDAS-PCI) in Japan.
• Inclusion of 8384 patients undergoing PCI for acute or stable coronary artery disease.
• Cubic spline curves used to model SBP-mortality relationships in the overall cohort and specific subgroups (age, sex, diabetes, LV hypertrophy, renal function, LV systolic function).

Main Results:

• Overall population: SBP of 110-130 mmHg was associated with the lowest mortality risk.
• Elderly (≥80 years), those with renal dysfunction, and preserved LV systolic function showed lowest mortality risk at higher SBP levels.
• Younger patients (<80 years), those with better renal function, and LV systolic dysfunction had lowest mortality risk at lower SBP levels.

Conclusions:

• The relationship between SBP and mortality risk is differential across various patient subgroups.
• Personalized SBP management is essential for optimizing outcomes in multimorbid patients with CAD undergoing PCI.
• Findings underscore the need to tailor BP targets based on individual patient characteristics and comorbidities.