Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation

Abstract

We sought to investigate the effect of ward-to-cath lab blood pressure (BP) differences on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). There are limited data available on the association between PCI with DES and BP differences on long-term clinical outcomes. This study enrolled 994 patients who underwent PCI with DES from March 2003 to August 2007. Resting BP was measured in a ward environment before transfer to the cardiac catheterization lab (cath lab), and again when the patient was laid down on the cath lab table. Patients were divided into two groups according to the difference in ward-to-cath lab systolic BP. Large difference group (n = 383) was defined as the absolute systolic difference of >20 mmHg and small difference group (n = 424) as the absolute systolic difference of ≤20 mmHg. The primary endpoints were all-cause mortality, cardiac death, nonfatal myocardial infarction and stroke. A total of 807 patients (mean age 60 ± 10 years, 522 males) received follow-up for 5.1 ± 2.4 years. The rate of all-cause mortality was significantly higher in the large difference group compared to the small difference group (6.6 vs. 2.8 %; adjusted hazard ratio (HR) 2.43; 95 % confidence interval (CI) 1.22-4.83; p = 0.012). There were higher cardiac deaths seen in the large difference group compared to the small difference group (3.9 vs. 1.4 %; adjusted HR 2.84; 95 % CI 1.1-7.31; p = 0.031). Stroke (2.4 vs. 1.2 %, p = 0.125) and TVR (3.7 vs. 1.7 %, p = 0.051) had higher trends in the large difference group compared to the small difference group. The composite of primary endpoints (all-cause mortality, cardiac death, nonfatal MI and stroke) occurred more frequently in the large difference group compared to the small difference group (10.0 vs. 6.4 %; adjusted HR 1.71; 95 % CI 1.04-2.81; p = 0.033). A difference in ward-to-cath lab systolic BP of >20 mmHg may contribute to increased adverse outcomes in the form of all-cause mortality and cardiac deaths in patients undergoing PCI with DES.

Impact of an Early Decrease in Systolic Blood Pressure on The Risk of Contrast-Induced Nephropathy after Percutaneous Coronary Intervention

“…In one previous study of patients with chronic kidney disease who developed CIN, the incidence of postprocedural hypotension was as high as 17.5%, whereas the preprocedural rate was only 5.3% [11]. A postprocedural decrease in SBP is likely to reflect cardiac dysfunction, vasovagal reflex, hypovolaemia, arterial stiffness or inappropriate antihypertensive treatment [12][13][14].…”

Incremental predictive value of the combined use of the neutrophil-to-lymphocyte ratio and systolic blood pressure difference after successful drug-eluting stent implantation

“…NLR was defined as the ratio of the neutrophil count to the lymphocyte count. The method of BP measurement has been described previously [ 10 ]. In brief, patients were measured with the resting right arm BP in the supine position in a ward setting, before transfer to the catheterization laboratory, where it was measured again after the patients had laid down on the catheterization laboratory table prior to any arterial puncture or PCI (ward-to-catheterization laboratory BP difference).…”

“…It would be very informative if we could predict long-term prognosis of the patients who are going to have CAG or PCI before these operations begin. Her et al [ 10 ] suggested that changes in peri-procedural BP may be significantly associated with major adverse cardiac events and reported that a difference in the ward-to-catheterization laboratory systolic BP (SBP) (ΔSBP) of > 20 mmHg was related to an increased rate of all-cause death and cardiac death (CD) after drug-eluting stent (DES) implantation. In actual clinical practice, minimally invasive or non-invasive, inexpensive diagnostic tools are preferred over invasive diagnostic tools in view of cost and patient safety [ 11 ].…”

“…In this regard, the NLR and ΔSBP are very useful non-invasive diagnostic tools for predicting adverse cardiac events. However, most previous studies [ 4 – 6 , 10 , 12 ] focused only on one of those two parameters. Moreover, data showing the complementary actions and combined usefulness of NLR and ΔSBP in patients diagnosed with acute coronary syndrome (ACS) are limited.…”

Higher visit-to-visit intra-dialytic blood pressure is associated with the progression of aortic valve stenosis in chronic hemodialysis patients

“…An alternative method is visit-tovisit BP monitoring, which allows multiple measurements and provides information about variability that is not obtained from a traditional clinic measurement. Increased BP variability, including visit-to-visit variability, was proven to be associated with subsequent stroke, [13][14][15][16] coronary artery disease [13,14,[16][17][18], and allcause mortality [19,20] in the general population. However, the association between visit-to-visit BP variability and progression of AS has not been elucidated in CHD patients.…”