What does this research mean for the field?

In acute coronary syndrome patients undergoing percutaneous coronary intervention, admission pulse pressure has a U-shaped relationship with long-term mortality (with lowest risk at 55 mm Hg), though this non-linear relationship is absent in patients with preserved ejection fraction (LVEF > 0.5). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 9, 2021Open Access

The U‐shape relationship between pulse pressure level on inpatient admission and long‐term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention

WHWei HuangChengdu Center for Disease Control and Prevention LHLI Hong-weiCapital Medical University SYSun YingCapital Medical University

Structured PICO

Does pulse pressure level on inpatient admission predict long-term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention?

Population

5,055 acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI), median age 64, 71.1% male, based in China. Key inclusion: consecutive in-hospital patients with ACS undergoing PCI. Key exclusion: inaccessible medical records, ACS caused by trauma/surgery/non-cardiovascular comorbidities, and death during hospitalization.

Intervention

Pulse pressure (PP) level on inpatient admission, evaluated as a continuous variable and categorized into low (≤49 mm Hg), intermediate (50-60 mm Hg), and high (≥61 mm Hg) groups.

Comparator

Intermediate pulse pressure group (50-60 mm Hg) or reference PP level of 55 mm Hg.

Outcome

All-cause mortality and cardiac mortality at median 24 months follow-up.hard clinical

In ACS patients undergoing PCI, there is a U-shaped relationship between admission pulse pressure and long-term mortality, driven primarily by patients with reduced left ventricular ejection fraction.

Abstract

The association between pulse pressure and long-term mortality was investigated among acute coronary syndrome (ACS) patients who received percutaneous coronary intervention (PCI). The study population included 5055 ACS patients in the Department of Cardiology of Beijing Friendship Hospital who were enrolled from January 2013 to July 2019. The median duration of follow-up was 24 months. Multivariate Cox regression was used to analyze the relationships between PP on inpatient admission and mortalities. Non-linear associations were studied by restricted cubic splines. Considering the heart function, the analyses were performed in the whole cohort and the LVEF > = 0.5 cohort separately. Subgroup analyses were performed according to the different diagnosis (the myocardial infarction subgroup and the unstable angina pectoris subgroup). When PP was used as categorical variable, the high PP group (≥61 mm Hg) significantly increased the risk of death compared with the intermediate PP group (50-60 mm Hg) in the both cohorts. When PP was used as continuous variable, a U-shape relationship were found between PP and mortalities in the whole cohort (p (for nonlinearity) = .005 and .003, respectively), with reference PP level of 55 mm Hg. However, this U-shape relationship disappeared in the LVEF > 0.5 cohort (p (for nonlinearity) = .111 and .117, respectively). The similar results were obtained in MI subgroup. From this study, the U-shape relationships between PP level and all-cause and cardiac mortalities were found in ACS patients who underwent PCI. The U-shape relationships disappeared in the LVEF > 0.5 cohort. The reference PP level was 55 mm Hg.

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