Ambulatory blood pressure and pulse rate patterns in acute coronary syndrome patients underwent percutaneous coronary
Tawithep Leowattana1, Supamongkol Phoopattana2, Suchat Sricholwattana2
1Department of Medicine, Faculty of Medicine.
Insights
In patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), a nondipping pulse rate pattern is linked to major adverse cardiac events (MACE). This finding highlights the importance of monitoring pulse rate variability post-PCI for improved patient outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Hypertension Research
Background:
- Acute coronary syndrome (ACS) is a critical condition requiring timely intervention.
- Percutaneous coronary intervention (PCI) is a common revascularization strategy for ACS.
- Ambulatory blood pressure (BP) monitoring offers insights into cardiovascular patterns beyond in-office measurements.
Purpose of the Study:
- To assess 24-hour ambulatory blood pressure and pulse rate patterns in ACS patients post-PCI.
- To investigate the association between these patterns and major adverse cardiac events (MACE).
Main Methods:
- Prospective cohort study involving 141 ACS patients undergoing PCI.
- 24-hour ambulatory BP and pulse rate monitoring conducted within two weeks post-PCI.
- Multivariable logistic regression and Cox proportional hazard models used for analysis.
Main Results:
- 22% of patients were nocturnal dipping BP dippers; others were nondippers (39.7%) or reverse dippers (38.3%).
- Nondipping BP was associated with nocturnal hypertension, elevated neutrophil-to-lymphocyte ratio, and increased mean platelet volume.
- A significant proportion (66.0%) exhibited nondipping pulse rate.
- Nondipping pulse rate independently predicted MACE (HR: 2.69, P=0.04).
Conclusions:
- Nondipping pulse rate is a significant independent predictor of MACE in ACS patients following PCI.
- Monitoring pulse rate patterns post-PCI may aid in identifying high-risk individuals.
Objectives:
To evaluate 24-h ambulatory systolic blood pressure (BP), diastolic BP, and pulse rate patterns in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI), and their association with major adverse cardiac events (MACE).
Methods:
We conducted a prospective cohort study in ACS patients in who ambulatory BP monitoring was recorded during 2 weeks post-PCI. Clinical and laboratory factors correlated with dipping BP and pulse rate were analyzed by multivariable logistic regression analysis. A Cox proportional hazard model was applied to find the associated factor(s) with their MACE.
Results:
We included 141 patients with ST-elevation myocardial infarction (STEMI) ( n = 47) and non-STEMI ( n = 94). The average age was 61.7 ± 11.1 years. Most of them are men (63.8%), had non-STEMI (66.7%), and triple vessel disease (51.1%). Upon assessment of nocturnal dipping BP, 22% were dippers, while the others were nondippers and reverse dippers (39.7 and 38.3%, respectively). Nocturnal hypertension, neutrophil-to-lymphocyte, and mean platelet volume were significantly associated with nondippers [adjusted odds ratio: 5.71, 95% confidence interval (CI): 2.51-12.99; 1.29, 95% CI: 1.01-1.63; 1.84, 95% CI: 1.16-2.93, respectively]. Nondipping pulse rate was found in 66.0% with a mean pulse rate of 75.4 ± 10.9 beats per minute (bpm) (awake) and 70.0 ± 11.2 bpm (sleep). Nondipping pulse rate was only found as an independent factor associated with MACE (hazard ratio: 2.69, 95% CI: 1.06-6.86, P = 0.04).
Conclusion:
This study demonstrated a significant association of MACE with nondipping pulse rate in patients with ACS who underwent PCI.
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