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Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome.
Arch Cardiovasc Dis. 2011 Aug; 104(8-9):435-43.AC

Abstract

BACKGROUND

The association between admission pulse pressure (PP) and cardiovascular outcomes in acute coronary syndrome (ACS) is not well defined.

AIM

To explore the prognostic value of initial PP in ST-segment elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTE-ACS).

METHODS

Over a 5-month period in 2007, 6704 consecutive patients with ACS were categorized into five groups according to initial PP: P1, PP ≤0; P2, PP 31-40; P3, PP 41-50; P4, PP 51-60; P5, PP>60mmHg. Patient characteristics and in-hospital outcomes were analysed.

RESULTS

Mean PP was lower in men versus women (55±19 vs. 61±22), young versus old (53±17 vs. 59±21), STEMI vs. NSTE-ACS (51±18 vs. 60±18) and patients who died versus survived (46±22 vs. 57±19mmHg) (P<0.001 for all). Most patients with low PP had a high Global Registry of Acute Coronary Events risk score. Compared with P5, crude odds ratios (ORs) (95% confidence intervals) for death were: P1, 9 (5.78-13.35); P2, 3 (1.71-4.06); P3, 1.5 (1.01-2.49); P4, 0.90 (0.51-1.58). After adjustment, low PP was associated with high mortality and stroke rates in ACS (adjusted ORs 7.5 [3.77-14.72] and 4.5 [1.20-18.88], respectively), high rates of recurrent ischaemia in NSTE-ACS (adjusted OR 2.8 [1.52-5.22]) and a high heart failure rate in STEMI (adjusted OR 2.1 [1.18-3.76]). Women with low PP had a higher mortality rate than men.

CONCLUSION

In ACS, all blood pressure variables were significantly correlated. Low PP was an independent predictor for stroke and mortality in overall ACS. Although PP was not superior to systolic blood pressure, only low PP was an independent predictor for recurrent ischaemia in NSTE-ACS.

Authors+Show Affiliations

Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital (HMC), Doha, Qatar.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21944145

Citation

El-Menyar, Ayman, et al. "Initial Hospital Pulse Pressure and Cardiovascular Outcomes in Acute Coronary Syndrome." Archives of Cardiovascular Diseases, vol. 104, no. 8-9, 2011, pp. 435-43.
El-Menyar A, Zubaid M, Almahmeed W, et al. Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome. Arch Cardiovasc Dis. 2011;104(8-9):435-43.
El-Menyar, A., Zubaid, M., Almahmeed, W., Alanbaei, M., Rashed, W., Al Qahtani, A., Singh, R., Zubair, S., & Al Suwaidi, J. (2011). Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome. Archives of Cardiovascular Diseases, 104(8-9), 435-43. https://doi.org/10.1016/j.acvd.2011.05.008
El-Menyar A, et al. Initial Hospital Pulse Pressure and Cardiovascular Outcomes in Acute Coronary Syndrome. Arch Cardiovasc Dis. 2011;104(8-9):435-43. PubMed PMID: 21944145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome. AU - El-Menyar,Ayman, AU - Zubaid,Mohammad, AU - Almahmeed,Wael, AU - Alanbaei,Muath, AU - Rashed,Wafa, AU - Al Qahtani,Awad, AU - Singh,Rajvir, AU - Zubair,Shahid, AU - Al Suwaidi,Jassim, Y1 - 2011/09/13/ PY - 2010/12/07/received PY - 2011/05/09/revised PY - 2011/05/09/accepted PY - 2011/9/28/entrez PY - 2011/9/29/pubmed PY - 2012/1/19/medline SP - 435 EP - 43 JF - Archives of cardiovascular diseases JO - Arch Cardiovasc Dis VL - 104 IS - 8-9 N2 - BACKGROUND: The association between admission pulse pressure (PP) and cardiovascular outcomes in acute coronary syndrome (ACS) is not well defined. AIM: To explore the prognostic value of initial PP in ST-segment elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTE-ACS). METHODS: Over a 5-month period in 2007, 6704 consecutive patients with ACS were categorized into five groups according to initial PP: P1, PP ≤0; P2, PP 31-40; P3, PP 41-50; P4, PP 51-60; P5, PP>60mmHg. Patient characteristics and in-hospital outcomes were analysed. RESULTS: Mean PP was lower in men versus women (55±19 vs. 61±22), young versus old (53±17 vs. 59±21), STEMI vs. NSTE-ACS (51±18 vs. 60±18) and patients who died versus survived (46±22 vs. 57±19mmHg) (P<0.001 for all). Most patients with low PP had a high Global Registry of Acute Coronary Events risk score. Compared with P5, crude odds ratios (ORs) (95% confidence intervals) for death were: P1, 9 (5.78-13.35); P2, 3 (1.71-4.06); P3, 1.5 (1.01-2.49); P4, 0.90 (0.51-1.58). After adjustment, low PP was associated with high mortality and stroke rates in ACS (adjusted ORs 7.5 [3.77-14.72] and 4.5 [1.20-18.88], respectively), high rates of recurrent ischaemia in NSTE-ACS (adjusted OR 2.8 [1.52-5.22]) and a high heart failure rate in STEMI (adjusted OR 2.1 [1.18-3.76]). Women with low PP had a higher mortality rate than men. CONCLUSION: In ACS, all blood pressure variables were significantly correlated. Low PP was an independent predictor for stroke and mortality in overall ACS. Although PP was not superior to systolic blood pressure, only low PP was an independent predictor for recurrent ischaemia in NSTE-ACS. SN - 1875-2128 UR - https://www.unboundmedicine.com/medline/citation/21944145/Initial_hospital_pulse_pressure_and_cardiovascular_outcomes_in_acute_coronary_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1875-2136(11)00248-8 DB - PRIME DP - Unbound Medicine ER -