Prognostic impact of blood pressure and heart rate at admission on in-hospital mortality after primary percutaneous intervention for acute myocardial infarction with ST-segment elevation in western Romania

Background: The purpose of this retrospective study was to evaluate the prognostic impact of systolic blood pressure (SBP) and heart rate (HR) on in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) patients, after primary percutaneous intervention (PCI). Patients and methods: The study included 294 patients admitted for STEMI. They were divided into five groups according to the SBP at admission: group I, <105 mmHg; group II, 105–125 mmHg; group III, 126–140 mmHg; group IV, 141–158 mmHg; and group V, ≥159 mmHg. Increased HR was defined as ≥80 beats per minute (bpm). In-hospital death was defined as all-cause death during admission and classified into cardiac and noncardiac death. Results: Among the 294 patients admitted for STEMI, 218 (74%) were men. The mean age was 62±17 years. In-hospital mortality rate was 6% (n=18), with 11 (3.7%) deaths having cardiac causes. The highest mortality was registered in group I (n=9, 16%, P =0.018). Compared to the other groups, group I patients were older ( P =0.033), more often smokers ( P =0.026), and had a history of myocardial infarction ( P =0.003), systemic hypertension ( P =0.023), diabetes ( P =0.041), or chronic kidney disease ( P =0.0200). They more often had a HR ≥80 bpm ( P =0.028) and a Killip class 3 or 4 at admission ( P =0.020). The peak creatine phosphokinase-MB level was significantly higher in this group ( P =0.005), while the angiographic findings more often identified as culprit lesions were the right coronary artery ( P =0.005), the left main trunk ( P =0.040), or a multivessel coronary artery disease ( P =0.044). Multivariate analysis showed that group I patients had a significantly higher risk for both all-cause death ( P =0.006) and cardiac death ( P =0.003). Patients with HR ≥80 bpm also had higher mortality rates ( P =0.0272 for general mortality and P =0.0280 for cardiac mortality). Conclusion: The present study suggests that SBP <105 mmHg and HR ≥80 bpm at admission of STEMI patients are associated with a higher risk of in-hospital death, even after primary PCI. Keywords: blood pressure, heart rate, STEMI, primary PCI, outcome