Impact of hypertension on infarct size in ST elevation myocardial infarction patients undergoing primary angioplasty

Abstract

Background: Hypertension is a well known risk factor for atherosclerosis. However, data on the impact of hypertension in patients with ST-segment elevation myocardial infarction (STEMI) are inconsistent, and mainly related to studies performed in the thrombolytic era, with very few data on patients undergoing primary angioplasty. The aim of the current study was to evaluate the impact of hypertension on scintigraphic infarct size in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Method: Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Results: Hypertension was associated with more advanced age (P < 0.001), a larger prevalence of diabetes (P ¼ 0.001), female sex (P < 0.001), but lower prevalence of smoking (P < 0.001) and anterior infarction (P ¼ 0.042). No difference was observed in ischemia time, cardiogenic shock at presentation, in preprocedural thrombolysis in myocardial infarction (TIMI) flow, and collateral circulation. Hypertension did not affect the rate of postprocedural TIMI 3 flow. Hypertension did not affect infarct size [12.5% (4.1-23.8%) vs. 12.8% (4.3-24.7%), P ¼ 0.38]. Similar results were observed in subanalyses in major high-risk subgroups. No impact of hypertension on infarct size was confirmed when the analysis was conducted according to the percentage of patients with infarct size above the median [adjusted odds ratio (95% CI) ¼ 0.97 (0.72-1.33),Conclusion: This study shows that among STEMI patients, undergoing primary PCI hypertension does not affect scintigraphic infarct size.

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

“…The reason why hypertension has no significant influence on the outcome in patients with STEMI who undergo PCI may be multifactorial. One possible interpretation is that patients with hypertensive STEMI did not show a larger infarct size compared with normotensive patients, depicted by De Luca G et al 's study 38. Another possible explanation was the altered lifestyle and standard antihypertensive therapy after STEMI which controlled the main cardiovascular risk factors and resulted in a relatively fair outcome 37.…”

Antecedent hypertension and myocardial injury in patients with reperfused ST-elevation myocardial infarction

“…Contrary, one might argue that a higher diastolic pressure could enhance coronary perfusion and collateral circulation with subsequently improved efficacy of reperfusion and limited expansion of myocardial necrosis. Studies investigating the impact of antecedent HTN on myocardial damage are very limited so far [29]. In particular, there is no study answering these questions by using the current reference standard technique, which is CMR [12].…”

Antecedent Hypertension and Myocardial Injury in Patients With Reperfused St-Elevation Myocardial Infarction

“…These additional assessed parameters, primarily microvascular obstruction, but also myocardial salvage index provide strong prognostic information that is incremental to clinical, biomarker, electrocardiographic, and angiographic risk markers [15,30]. To the best of our knowledge, the study by De Luca et al [29]. is the first and only study that evaluated the impact of HTN on infarct size in 830 STEMI patients undergoing PPCI.…”

“…Contrary, one might argue that a higher diastolic pressure could enhance coronary perfusion and collateral circulation with subsequently improved efficacy of reperfusion and limited expansion of myocardial necrosis. Studies investigating the impact of antecedent HTN on myocardial damage are very limited so far [29].…”