Key result
Normal presenting systolic blood pressure in STEMI patients was associated with higher in-hospital mortality compared to high blood pressure (adjusted HR 2.268; 95% CI 1.144-4.498; P=0.019).
Why the study?
Does normal presenting systolic blood pressure worsen clinical outcomes compared to high presenting blood pressure in patients with STEMI undergoing PCI?
Cohort (n=11,292)
Does normal presenting systolic blood pressure worsen clinical outcomes compared to high presenting blood pressure in patients with STEMI undergoing PCI?
In patients with STEMI undergoing PCI, a normal presenting systolic blood pressure is paradoxically associated with higher in-hospital mortality and poorer cardiac function compared to a high presenting blood pressure.
BACKGROUND: We evaluated the impact of normal vs. high presenting blood pressure (BP) on clinical outcomes and cardiac function in patients with ST-elevation myocardial infarction (MI). METHODS: In 11,292 patients, in-hospital mortality and major adverse clinical events (MACE; all-cause death, nonfatal MI, or any revascularization) during follow-up were compared between patients with normal (≥ 100 mm Hg and ≤ 139 mm Hg) and high (≥ 140 mm Hg) systolic BP at presentation. RESULTS: Compared to patients with high BP, patients with normal BP had significantly higher in-hospital mortality (1.5% vs. 3.7%; P < 0.001), especially in those with prior hypertension, and higher rates of all-cause death (3.3% vs. 5.3%; P < 0.001) and MACE (9.8% vs. 11.8%; P = 0.04) during follow-up (median: 330 days). After multivariate adjustment, normal BP was associated with higher risk of in-hospital mortality (adjusted hazard ratio (HR) = 2.268; 95% confidence interval (CI) = 1.144-4.498; P = 0.019), but not all-cause death (adjusted HR = 0.956; 95% CI = 0.602-1.517) or MACE (adjusted HR = 0.935; 95% CI = 0.755-1.158). Left ventricular ejection fraction at baseline and follow-up was significantly lower in patients with normal BP (52% vs. 51%; P < 0.001 and 55% vs. 54%; P = 0.018, respectively). CONCLUSIONS: Our findings indicate that patients with normal presenting BP, especially those with prior hypertension, exhibit higher in-hospital mortality and poorer cardiac function compared to patients with high BP. Although outcomes during follow-up did not differ, cardiac function was persistently poorer in patients who presented with normal BP.
No takes yet. Share an insight, caveat, or question.
Park et al. (2014) conducted a cohort in ST-elevation myocardial infarction (n=11,292). Normal presenting systolic blood pressure (≥ 100 mm Hg and ≤ 139 mm Hg) vs. High presenting systolic blood pressure (≥ 140 mm Hg) was evaluated on in-hospital mortality (adjusted HR 2.268, 95% CI 1.144-4.498, p=0.019). Normal presenting systolic blood pressure in STEMI patients was associated with higher in-hospital mortality compared to high blood pressure (adjusted HR 2.268; 95% CI 1.144-4.498; P=0.019).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: