Key result
In patients with acute myocardial infarction and multivessel disease who underwent revascularization, an average on-treatment diastolic blood pressure < 70 mmHg increased the risk of all-cause death by 47% (HR 1.47).
Why the study?
It was hypothesized that the J-shaped relationship between low DBP and adverse outcomes after AMI differs between multivessel disease and single-vessel disease due to differing myocardial ischemic burden.
Does low diastolic blood pressure (< 70 mmHg) increase mortality in AMI patients with multivessel disease compared to single-vessel disease after revascularization?
Cohort (n=9,983)
Yes
Does low diastolic blood pressure (< 70 mmHg) increase mortality in AMI patients with multivessel disease compared to single-vessel disease after revascularization?
Hazard Ratio: 1.47 (95% CI 1.06–2.04)
p-value: p=0.012
A J-shaped relationship between low diastolic blood pressure (<70 mmHg) and increased mortality persists in AMI patients with multivessel disease after revascularization, but not in those with single-vessel disease.
BACKGROUND: Previous studies demonstrated a J-shaped relationship between low diastolic blood pressure (DBP) and adverse clinical outcomes in patients with acute myocardial infarction (AMI) that was sensitive to revascularization. Hypothesized herein, was that this relationship differs between patients with multivessel disease (MVD) and those with single-vessel disease due to differing degrees of myocardial ischemic burden. METHODS: Among 9,983 AMI patients from the Korea Acute Myocardial Infarction Registry database who underwent percutaneous coronary intervention and were followed up for a median duration of 3.2 years, average on-treatment DBP was calculated at admission, discharge, and every scheduled visit and divided into these parameters: < 70 mmHg, 70-74 mmHg, 75-79 mmHg, and ≥ 80 mmHg. The relationship between average on-treatment DBP and clinical outcomes including all-cause death, cardiovascular (CV) death, non-CV death, and hospitalization for heart failure was analyzed using the Cox regression models adjusted for clinical covariates. RESULTS: In patients with MVD, all-cause death (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.06-2.04, p = 0.012) and CV death (HR: 1.59; 95% CI: 1.02-2.46, p = 0.027) were significantly increased in patients with a DBP < 70 mmHg, showing a J-shaped relationship. However, these findings were not significant for single-vessel disease. On a sensitivity analysis excluding subjects with a baseline SBP < 120 mmHg, an increased risk of a low DBP < 70 mmHg remained in MVD. CONCLUSIONS: The J-shaped relationship between low DBP and adverse clinical outcomes in AMI patients who underwent revascularization persisted in MVD, which has a high ischemic burden. These high-risk patients require cautious treatment.
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Kim et al. (2022) conducted a cohort in Acute myocardial infarction (n=9,983). Average on-treatment diastolic blood pressure < 70 mmHg vs. Average on-treatment diastolic blood pressure 75-79 mmHg was evaluated on All-cause mortality in patients with multivessel disease (HR 1.47, 95% CI 1.06-2.04, p=0.012). In patients with acute myocardial infarction and multivessel disease who underwent revascularization, an average on-treatment diastolic blood pressure < 70 mmHg increased the risk of all-cause death by 47% (HR 1.47).
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