Key result
Reverse dipper BP rhythm is linked to a ~6-fold increase in post-STEMI MACE.
Why the study?
To investigate the characteristics of blood pressure circadian rhythm disruption and its relationship with prognosis in patients with acute anterior STEMI after emergency PCI.
Does a reverse dipper blood pressure circadian rhythm increase the risk of major adverse cardiovascular events in patients with acute anterior STEMI after emergency PCI?
Cohort (n=461)
No
Does a reverse dipper blood pressure circadian rhythm increase the risk of major adverse cardiovascular events in patients with acute anterior STEMI after emergency PCI?
Hazard Ratio: 6.417 (95% CI 1.94–21.2)
Absolute Event Rate: 39.39% vs 13.51%
p-value: p=0.002
In patients with acute anterior STEMI undergoing emergency PCI, a reverse dipper blood pressure circadian rhythm is independently associated with a significantly increased risk of major adverse cardiovascular events at 1 year.
May aid post-PCI risk stratification in anterior STEMI; hypothesis-generating for circadian BP interventions.
OBJECTIVE: To investigate the characteristics of blood pressure (BP) circadian rhythm disruption and its relationship with prognosis in patients with acute anterior ST-elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI). METHODS: A total of 330 patients with anterior STEMI who underwent emergency PCI were enrolled in this study (MI group). Additionally, 131 physical examination patients were selected as the control group. Based on 24-h ambulatory blood pressure monitoring (ABPM) results, BP rhythm in both groups was classified into Extreme dipper, Dipper, Non-dipper, and Reverse dipper. The characteristics of BP rhythm were compared between the two groups. Patients with anterior MI were followed up for 1 year postoperatively. The occurrence of major adverse cardiovascular events (MACE) was compared among subgroups with different BP rhythms. RESULTS: The proportion of dipper BP in the study group (11.21%) was significantly lower than that of the control group (63.36%) (p = 0.001). The proportions of non-dipper (43.03%) and reverse dipper (40%) BP in the MI group were higher than the control group (22.90% and 7.63%, respectively; all p < 0.001). Multivariate Cox regression analysis, using dipper BP as the reference, showed that reverse dipper BP was independently associated with MACE (HR = 6.417, p = 0.002). The cumulative risk of the primary endpoint event (Log Rank p = 0.021) was significantly higher in the reverse dipper group compared to the dipper group. CONCLUSION: Patients with anterior STEMI are still under the burden of disrupted BP circadian rhythm and reduced dipper BP rhythm. The reverse dipper BP rhythm may serve as an independent factor of MACE.
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Shao et al. (2026) conducted a cohort in Acute anterior STEMI after emergency PCI (n=461). Reverse dipper blood pressure rhythm vs. Dipper blood pressure rhythm was evaluated on Major adverse cardiovascular events (MACE) (HR 6.417, 95% CI 1.94-21.20, p=0.002). Reverse dipper blood pressure rhythm was independently associated with an increased risk of MACE compared to dipper rhythm in patients with acute anterior STEMI (HR 6.417).
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