Joint effects of pulse pressure and LVEF on 12-month mortality in acute coronary syndrome patients undergoing PCI

To evaluate admission pulse pressure (PP) as an independent predictor of 12-month mortality in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), and to explore its joint effect with left ventricular ejection fraction (LVEF).

This observational study analyzed 2213 consecutive ACS patients from the BIPass study who underwent PCI. Patients were stratified by LVEF (>50% vs. ≤50%) and PP levels (≤ 40 mmHg, 40 < PP ≤ 60 mmHg, 60 < PP ≤ 80 mmHg, and > 80 mmHg). Primary endpoint was cardiac death, secondary endpoint was 12-month all-cause death. Restricted cubic spline (RCS) and Cox models assessed PP-mortality associations after adjusting for confounders; PP-LVEF interaction was visualized via heatmap and 3D surface plot.

During follow-up, 37 all-cause deaths (1.67%) and 22 cardiac deaths (0.99%) were recorded. RCS confirmed a U-shaped PP-12-month mortality association (lowest risk: 41-60 mmHg). Multivariable analysis showed low PP (≤ 40 mmHg; adjusted HR = 18.21, 95% CI:1.65-201.01, P = 0.018) and high PP (> 80 mmHg; adjusted HR = 18.91, 95% CI:2.05-174.93, P = 0.010) independently predicted cardiac death. In LVEF ≤50% patients, extreme PP elevated cardiac death (P = 0.004) and all-cause death (P = 0.044); in LVEF >50% patients, only high PP increased outcomes (cardiac death: P = 0.034; all-cause death: P = 0.028), with low PP showing no significance.

Admission PP has a U-shaped association with 12-month mortality in post-PCI ACS patients. Reduced LVEF amplifies extreme PP's adverse effects. Integrated PP-LVEF assessment enhances risk stratification and guides personalized management.