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Title: Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention.
Austin Authors: Warren, Josephine;Nanayakkara, Shane;Andrianopoulos, Nick;Brennan, Angela;Dinh, Diem;Yudi, Matias B ;Clark, David J ;Ajani, Andrew E;Reid, Christopher M;Selkrig, Laura;Shaw, James;Hiew, Chin;Freeman, Melanie;Kaye, David;Kingwell, Bronwyn A;Dart, Anthony M;Duffy, Stephen J
Affiliation: Austin Health
Geelong Hospital, Geelong, Victoria, Australia
Royal Melbourne Hospital, Melbourne, Victoria, Australia
Alfred Hospital, Melbourne, Victoria, Australia
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
Box Hill Hospital, Melbourne, Victoria, Australia
Issue Date: 11-Jun-2019
Publication information: Journal of the American College of Cardiology 2019; 73(22): 2846-2855
Abstract: High systolic blood pressure (SBP) increases cardiac afterload, whereas low diastolic blood pressure (DBP) may lead to impaired coronary perfusion. Thus, wide pulse pressure (high systolic, low diastolic [HSLD]) may contribute to myocardial ischemia and also be a predictor of adverse cardiovascular events. The purpose of this study was to determine the relationship between pre-procedural blood pressure and long-term outcome following percutaneous coronary intervention (PCI). The study included 10,876 consecutive patients between August 2009 and December 2016 from the Melbourne Interventional Group registry undergoing PCI with pre-procedural blood pressure recorded. Patients with ST-segment elevation myocardial infarction, cardiogenic shock, and out-of-hospital cardiac arrest were excluded. Patients were divided into 4 groups according to SBP (high ≥120 mm Hg, low <120 mm Hg) and DBP (high >70 mm Hg, low ≤70 mm Hg). Mean pulse pressure was 60 ± 21 mm Hg. Patients with HSLD were older and more frequently women, with higher rates of hypercholesterolemia, renal impairment, diabetes, and multivessel and left main disease (all p ≤ 0.0001). There was no difference in 30-day major adverse cardiac events, but at 12 months the HSLD group had a greater incidence of myocardial infarction (p = 0.018) and stroke (p = 0.013). Long-term mortality was highest for HSLD (7.9%) and lowest for low systolic, high diastolic (narrow pulse pressure) at 2.1% (p = 0.0002). Cox regression analysis demonstrated significantly lower long-term mortality in the low systolic, high diastolic cohort (hazard ratio: 0.50; 99% confidence interval: 0.25 to 0.98; p = 0.04). Pulse pressure at the time of index PCI is associated with long-term outcomes following PCI. A wide pulse pressure may serve as a surrogate marker for risk following PCI and represents a potential target for future therapies.
DOI: 10.1016/j.jacc.2019.03.493
ORCID: 0000-0002-3706-4150
Journal: Journal of the American College of Cardiology
PubMed URL: 31171090
Type: Journal Article
Subjects: blood pressure
coronary artery disease
percutaneous coronary intervention
pulse pressure
Appears in Collections:Journal articles

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