Key result
High visit-to-visit systolic blood pressure variability in STEMI survivors significantly increased the risk of major adverse cardiovascular events by 57% compared to low variability (HR 1.57).
Why the study?
Elevated visit-to-visit blood pressure variability is associated with cardiovascular events, but its prognostic impact after STEMI has not been established.
Does high visit-to-visit systolic blood pressure variability increase the risk of major adverse cardiovascular events in STEMI survivors?
Cohort (n=343)
No
Does high visit-to-visit systolic blood pressure variability increase the risk of major adverse cardiovascular events in STEMI survivors?
Hazard Ratio: 1.57 (95% CI 1.03–2.39)
Absolute Event Rate: 38% vs 26%
p-value: p=0.038
High visit-to-visit systolic blood pressure variability is associated with an increased risk of major adverse cardiovascular events in STEMI survivors.
Elevated visit-to-visit blood pressure variability (BPV), independent of mean BP, has been associated with cardiovascular events. However, its impact after ST-elevation myocardial infarction (STEMI) has not been established. This study aimed to investigate the prognostic impact of BPV on patients after STEMI. We analyzed the data and clinical outcomes of STEMI survivors who underwent successful primary coronary intervention from 2003 to 2009. BP was measured at discharge and at 1, 3, 6, 12, 24, and 36 months, and we calculated BPV as the intra-individual standard deviations (SDs) of systolic BP (SBP) across these measurements. We classified the patients as high and low-BPV group, and evaluated the outcomes: occurrence of major adverse cardiovascular events (MACEs), death, recurrent myocardial infarction, and target vessel revascularization within 60 months. We enrolled 343 patients, and mean follow-up duration was 68 ± 34 months (median: 76 months). Mean and median SBP SDs were 13.2 and 12.3 mmHg, and patients were divided into one of the two groups based on the median (high-BPV group = SD ≥ 12.3 mmHg; low-BPV group = SD < 12.3 mmHg). The MACE-free survival in the high-BPV group was significantly worse than that in low-BPV group (log-rank p = 0.035). For the high-BPV group, the risk of a MACE significantly increased by 57% (95% confidence interval: 1.03-2.39; p = 0.038). Visit-to-visit systolic BPV was associated with increased rates of adverse clinical outcomes in patients after STEMI. Careful assessment of BP and attempts to reduce BPV might be also important in STEMI survivors.
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Soh et al. (2019) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=343). High visit-to-visit systolic blood pressure variability (SD ≥ 12.3 mmHg) vs. Low visit-to-visit systolic blood pressure variability (SD < 12.3 mmHg) was evaluated on Major adverse cardiovascular events (MACEs) (HR 1.57, 95% CI 1.03-2.39, p=0.038). High visit-to-visit systolic blood pressure variability in STEMI survivors significantly increased the risk of major adverse cardiovascular events by 57% compared to low variability (HR 1.57).
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