Key result
In STEMI, admission SBP below 120 mmHg is linked to ~20% less spontaneous reperfusion per 10-mmHg drop.
Why the study?
The study aimed to evaluate the associations of admission systolic blood pressure with spontaneous reperfusion and long-term prognosis in STEMI patients.
Does admission systolic blood pressure > 120 mmHg improve spontaneous reperfusion and reduce mortality in STEMI patients undergoing primary percutaneous coronary intervention?
Observational (n=3,809)
Yes
Does admission systolic blood pressure > 120 mmHg improve spontaneous reperfusion and reduce mortality in STEMI patients undergoing primary percutaneous coronary intervention?
In STEMI patients undergoing primary PCI, an admission systolic blood pressure between 121 and 150 mmHg is associated with higher rates of spontaneous reperfusion and improved long-term survival compared to an SBP ≤ 120 mmHg.
Low admission SBP associated with reduced spontaneous reperfusion in STEMI; leaves open optimal targets, requiring prospective trials before practice change.
BACKGROUND: This study aims to assess the associations of admission systolic blood pressure (SBP) level with spontaneous reperfusion (SR) and long-term prognosis in ST-elevation myocardial infarction (STEMI) patients. METHODS: Data from 3809 STEMI patients who underwent primary percutaneous coronary intervention within 24 h, as recorded in the Chinese STEMI PPCI Registry (NCT04996901), were analyzed. The primary endpoint was SR, defined as thrombolysis in myocardial infarction grade 2-3 flow of IRA according to emergency angiography. The second endpoint was 2-year all-cause mortality. The association between admission BP and outcomes was evaluated using Logistic regression or Cox proportional hazards models with restricted cubic splines, adjusting for clinical characteristics. RESULTS: Admission SBP rather than diastolic BP was associated with SR after adjustment. Notably, this relationship exhibits a nonlinear pattern. Below 120mmHg, There existed a significant positive correlation between admission SBP and the incidence of SR (adjusted OR per 10-mmHg decrease for SBP ≤ 120 mm Hg: 0.800; 95% CI: 0.706-0.907; p<0.001); whereas above 120mmHg, no further improvement in SR was observed (adjusted OR per 10-mmHg increase for SBP >120 mm Hg: 1.019; 95% CI: 0.958-1.084, p = 0.552). In the analysis of the endpoint event of mortality, patients admitted with SBP ranging from 121 to 150 mmHg exhibited the lowest mortality compared with those SBP ≤ 120mmHg (adjusted HR: 0.653; 95% CI: 0.495-0.862; p = 0.003). In addition, subgroups analysis with Killip class I-II showed SBP ≤ 120mmHg was still associated with increased risk of mortality. CONCLUSION: The present study revealed admission SBP above 120 mmHg was associated with higher SR,30-d and 2-y survival rate in STEMI patients. The admission SBP could be a marker to provide clinical assessment and treatment. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04996901), 07/27/2021.
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Hu et al. (2024) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=3,809). Admission systolic blood pressure (SBP) was evaluated on Spontaneous reperfusion (SR) (OR 0.800, 95% CI 0.706-0.907, p=<0.001). In STEMI patients, admission systolic blood pressure below 120 mmHg was positively correlated with spontaneous reperfusion (adjusted OR 0.800 per 10-mmHg decrease), with no further improvement observed above 120 mmHg.
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