1. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention
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Josephine Warren, Shane Nanayakkara, Nick Andrianopoulos, Angela Brennan, Diem Dinh, Matias Yudi, David Clark, Andrew E. Ajani, Christopher M. Reid, Laura Selkrig, James Shaw, Chin Hiew, Melanie Freeman, David Kaye, Bronwyn A. Kingwell, Anthony M. Dart, Stephen J. Duffy, Chris Reid, Andrew Ajani, Stephen Duffy, Ernesto Oqueli, S.J. Duffy, J.A. Shaw, A. Walton, A. Dart, A. Broughton, J. Federman, C. Keighley, C. Hengel, K.H. Peter, D. Stub, W. Chan, J. Warren, J. O’Brien, L. Selkrig, R. Huntington, D.J. Clark, O. Farouque, M. Horrigan, J. Johns, L. Oliver, J. Brennan, R. Chan, G. Proimos, T. Dortimer, B. Chan, V. Nadurata, R. Huq, D. Fernando, A. Al-Fiadh, M. Yudi, H. Sugumar, J. Ramchand, H. Han, S. Picardo, L. Brown, E. Oqueli, A. Sharma, B. Zhu, N. Ryan, T. Harrison, G. New, L. Roberts, M. Freeman, M. Rowe, Y. Cheong, C. Goods, A. Teh, S. Parfrey, J. Ramzy, A. Koshy, P. Venkataraman, D. Flannery, C. Hiew, M. Sebastian, T. Yip, Michael Mok, C. Jaworski, A. Hutchinson, C. Cimenkaya, P. Ngu, B. Khialani, H. Salehi, M. Turner, J. Dyson, B. McDonald, D. Van Den Nouwelant, K. Halliburton, C. Reid, N. Andrianopoulos, A.L. Brennan, D. Dinh, B.P. Yan, A.E. Ajani, R. Warren, D. Eccleston, J. Lefkovits, R. Iyer, R. Gurvitch, W. Wilson, M. Brooks, S. Biswas, and J. Yeoh
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,medicine.disease ,Pulse pressure ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Afterload ,Heart failure ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background 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. Objectives The purpose of this study was to determine the relationship between pre-procedural blood pressure and long-term outcome following percutaneous coronary intervention (PCI). Methods 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 70 mm Hg, low ≤70 mm Hg). Results 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). Conclusions 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.
- Published
- 2019
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