Key result
Systolic blood pressure ≤90 mmHg during the first week of hospitalization was associated with higher long-term all-cause mortality compared to 110-120 mmHg (HR 7.12; 95% CI 3.13-16.19; p<0.001).
Why the study?
Optimal blood pressure control is necessary in AMI, but associations between blood pressure control in the first 7 days of hospitalization and long-term mortality specifically in isolated left ventricular MI were not well defined.
Does blood pressure in the first 7 days of hospitalization affect long-term mortality in patients with acute left ventricular myocardial infarction?
Cohort (n=3,108)
Does blood pressure in the first 7 days of hospitalization affect long-term mortality in patients with acute left ventricular myocardial infarction?
Maintaining a systolic blood pressure of 90-130 mmHg and diastolic blood pressure of 60-80 mmHg during the first week of hospitalization is associated with improved long-term survival in patients with acute left ventricular myocardial infarction.
Early post-MI SBP ≤90 mmHg was associated with higher long-term mortality; leaves open optimal BP targets in AMI.
BACKGROUND: Previous studies have shown that optimal blood pressure (BP) control is necessary to outcomes in patients with acute myocardial infarction (AMI). Acute left ventricular MI is a prevalent type of AMI with poor prognosis. We aimed to analyze the associations between BP control in the first 7 days of hospitalization and long-term mortality specific to patients with isolated left ventricular MI. METHODS: A total of 3108 acute left ventricular MI patients were included in this analysis. The average BP on the first seven days of hospitalization was categorized into 10-mmHg increments. The primary and secondary outcomes were all-cause death and cardiac death, respectively. Cox models were used to assess the association of outcomes with BP during hospitalization. RESULTS: The median length-of-stay was 7 (IQR 6-10) days. The relationship between systolic BP (SBP) or diastolic BP (DBP) followed a U-shaped curve association with outcomes. All-cause mortality was higher in patients with lower SBP (≤90 mmHg) (adjusted hazard ratios (HRs) 7.12, 95% confidence interval (CI) 3.13-16.19; p < 0.001) and DBP (<60 mmHg) (HR 1.76, 95% CI 1.14-2.71; p = 0.011) [reference: 110 < SBP ≤120 mmHg; 70 < DBP ≤ 80 mmHg], respectively. Furthermore, primary outcome was higher in patients with higher SBP (>130 mmHg) (HR 1.51, 95% CI 1.12-2.03; p = 0.007) and DBP (>80 mmHg) (HR 1.61, 95% CI 1.20-2.18; p = 0.002), respectively. CONCLUSION: Maintaining a SBP from 90 to 130 mmHg and a DBP from 60 to 80 mmHg may be beneficial to patients with acute left ventricular MI in the long run.
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Tang et al. (2021) conducted a cohort in acute left ventricular myocardial infarction (n=3,108). Systolic blood pressure ≤90 mmHg vs. Systolic blood pressure 111-120 mmHg was evaluated on all-cause death (HR 7.12, 95% CI 3.13-16.19, p=< 0.001). Systolic blood pressure ≤90 mmHg during the first week of hospitalization was associated with higher long-term all-cause mortality compared to 110-120 mmHg (HR 7.12; 95% CI 3.13-16.19; p<0.001).
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