Key result
Admission pulse pressure <50 mmHg was associated with a significantly higher risk of long-term cardiac death (HR 1.89) compared to 50-59 mmHg in elderly patients with type 2 diabetes and acute coronary syndrome.
Why the study?
To evaluate the effect of admission pulse pressure on long-term cardiac and all-cause mortality in elderly patients with type 2 diabetes mellitus admitted for acute coronary syndrome.
Does admission pulse pressure predict long-term cardiac and all-cause mortality in elderly patients with T2DM admitted for ACS?
Cohort (n=2,587)
No
Does admission pulse pressure predict long-term cardiac and all-cause mortality in elderly patients with T2DM admitted for ACS?
Hazard Ratio: 1.89 (95% CI 1.16–3.06)
Absolute Event Rate: 9% vs 4.1%
p-value: p=0.010
Admission pulse pressure exhibits a U- or J-shaped relationship with long-term mortality in elderly diabetic patients with ACS, with the lowest risk observed at 50-59 mmHg.
Should not yet guide risk stratification or management in elderly T2DM-ACS patients; leaves open whether low pulse pressure extends prognostic models pending prospective validation.
Objective The aim of this study was to assess the effect of pulse pressure (PP) at admission on long-term cardiac and all-cause mortality among elderly patients with type 2 diabetes mellitus (T2DM) admitted for acute coronary syndrome (ACS). Methods This is a retrospective observational study. The patients aged at least 65 years with T2DM and ACS from January 2013 to April 2018 were enrolled and divided into 4 groups according to admission PP: <50 mmHg; 50–59 mmHg; 60–69 mmHg, and ≥70 mmHg. Multivariate Cox proportional hazard regression analyses and restricted cubic spline were performed to determine the association between PP and outcomes (cardiac and all-cause death). Results A total of 2,587 consecutive patients were included in this cohort study. The mean follow-up time was 39.2 months. The incidences of cardiac death and all-cause death were 6.8% (n = 176) and 10.8% (n = 280), respectively. After multivariate adjustment in the whole cohort, cardiac and all-cause mortality were significantly higher in PP <50 mmHg group and PP ≥70 mmHg group, compared with PP 50–59 mmHg group. Further analysis in acute myocardial infarction (AMI) subgroup confirmed that PP <50 mmHg was associated with cardiac death [hazard ratios (HR) 2.92, 95% confidence interval (CI) 1.45–5.76, P = 0.002] and all-cause death (HR 2.08, 95% CI 1.20–3.58, P = 0.009). Meanwhile, PP ≥70 mmHg was associated with all-cause death (HR 1.78, 95% CI 1.05–3.00, P = 0.031). However, admission PP did not appear to be a significant independent predictor in unstable angina pectoris (UAP) subgroup. There is a U-shaped correlation between PP and cardiac and all-cause mortality in the whole cohort and UAP subgroup and a J-shaped correlation in the AMI subgroup, both with a nadir at 50–59 mmHg. Conclusion In elderly patients with T2DM admitted for ACS, admission PP is an independent and strong predictor for long-term cardiac and all-cause mortality, especially in patients with AMI.
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Wang et al. (2022) conducted a cohort in Type 2 Diabetes Mellitus and Acute Coronary Syndrome (n=2,587). Admission pulse pressure <50 mmHg vs. Admission pulse pressure 50-59 mmHg was evaluated on Cardiac death during hospitalization and over the follow-up period (HR 1.89, 95% CI 1.16-3.06, p=0.010). Admission pulse pressure <50 mmHg was associated with a significantly higher risk of long-term cardiac death (HR 1.89) compared to 50-59 mmHg in elderly patients with type 2 diabetes and acute coronary syndrome.
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