Clinical characteristics and short-term outcomes in patients with elevated admission systolic blood pressure after acute ST-elevation myocardial infarction: a population-based study

Abstract

ObjectivePrognostic value of lower admission systolic blood pressure (SBP) in patients with acute myocardial infarction has been confirmed, but the impact of elevated admission SBP on short-term outcomes has been evaluated only by a limited number of studies and they have reported conflicting results. The aim of our study was to investigate the characteristics and short-term outcomes in patients with elevated admission SBP after ST-elevation myocardial infarction (STEMI).DesignA population-based, observational study.SettingThe multicentre registry in China.ParticipantsA total of 7510 consecutive patients with STEMI were registered. Patients were divided into three groups according to admission SBP: normal admission SBP (100–139 mm Hg), modestly elevated admission SBP (140–179 mm Hg) and excessively elevated admission SBP (≥180 mm Hg). The primary outcomes were 7-day and 30-day all-cause mortality, major adverse cardiac events (MACE) and bleeding rate.ResultsOf 6591 patients, 4182 (63.5%) had normal admission SBP, 2187 (33.2%) modestly elevated admission SBP and 222 (3.4%) excessively elevated admission SBP. Patients with elevated admission SBP had a high-risk profile, such as were more likely to be older, with more concomitant cardiovascular morbidities, presenting with more events of anterior myocardial infarction and less reperfusion treatment. However, 7-day and 30-day all-cause mortality, MACE and bleeding rate were comparable among groups (all p>0.05). Survival curves and MACE curves were similar among groups (p=0.377 and 0.375, respectively). After multivariate adjustment, elevated admission SBP was not associated with increased risk of short-term death and bleeding, and MACE was comparable with normal admission SBP.ConclusionsAlthough those with elevated admission SBP after STEMI were at a higher risk for cardiovascular events, they did not have poorer short-term outcomes compared with patients with normal admission SBP.

In-Hospital Major Adverse Cardiac Events Factor Predictors on ST-Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention at dr. Cipto Mangunkusumo General Hospital

“…Hypertension was also not found to be significantly associated with the presence of MACE during the treatment of STEMI patients undergoing PPCI. Similar results were found by Huang et al 26 , with no significant difference in the occurrence of MACE during treatment in STEMI patients. The use of antihypertensive drugs such as angiotensin converting-enzyme blockers and beta blockers in the adequate management of STEMI can be cardioprotective for the occurrence of MACE.…”

Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion

“…The initial blood pressure value registered during an acute coronary event is not necessarily representative of the baseline patient’s blood pressure control. Furthermore, the prognostic value of high systolic blood pressure values at admission in the setting of an acute STEMI remains controversial [ 29 – 32 ].…”

Impact of hypertension on the outcome of patients admitted with acute coronary syndrome

“…A previous study suggested that ACS mortality is strongly related to admission BP with a J-shaped or U-shaped curve association, with the lowest adverse event rates in the SBP range of 130-140 mmHg and DBP range of 80-90 mmHg [8]. A large study showed that elevated admission SBP in patients with ST-segment elevation myocardial infarction (STEMI) was not associated with worse outcomes [9]. We assumed that preexisting hypertension might be protective in ACS patients in the short term despite its clearly established role in increasing the long-term risk for coronary artery disease.…”