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Preprocedural Blood Pressure and Long-Term Outcomes After PCI
Study Questions:
What is the relationship between preprocedural blood pressure (BP), pulse pressure, and long-term outcomes following percutaneous coronary intervention (PCI)?
Methods:
The study included 10,875 consecutive patients between August 2009 and December 2016, from the Melbourne Interventional Group registry, who underwent PCI. Patient were grouped based on their systolic BP (SBP) and diastolic BP (DBP) to create four groups: high-systolic, low-diastolic (HSLD); low-systolic, high-diastolic (LSHD); high-systolic, high-diastolic (HSHD); and low-systolic, low-diastolic (LSLD). These distinctions were made using SBP threshold of 120 mm Hg and DBP of 70 mm Hg. Thirty-day and 12-month mortality were captured via chart review and patient phone call.
Results:
The mean pulse pressure was 60 ± 21 mm Hg. Patients with HSLD (wide pulse pressure) were older, more often women, and had higher rates of hyperlipidemia, renal insufficiency, diabetes, and multivessel or left main disease. There was no difference in 30-day adverse cardiac events between the four groups. At 12 months, patients with HSLD (wide pulse pressure) had a greater incidence of subsequent myocardial infarction and stroke. Twelve-month mortality was highest for patients with HSLD (wide pulse pressure; 7.9%) and lowest for patients with LSHD (narrow pulse pressure; 2.1%, hazard ratio 0.50, 95% confidence interval 0.25-0.98).
Conclusions:
The authors concluded that pulse pressure at the time of index PCI is associated with long-term outcomes following PCI.
Perspective:
Hypertension is a well-established cardiovascular risk factor. There has also been a longstanding concern about low DBP being associated with poor coronary artery perfusion. This study lends support to that notion, since patients with low DBP had higher rates of adverse cardiovascular events. This was most pronounced in patients with a wide pulse pressure (HSLD cohort). It also points to the need to adequately manage cardiovascular risk factors (including hypertension) as early as possible to avoid arterial stiffness that is often associated with wide pulse pressure.
Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Hypertension
Keywords: Blood Pressure, Blood Pressure Determination, Coronary Artery Disease, Diabetes Mellitus, Diastole, Hyperlipidemias, Hypertension, Myocardial Infarction, Percutaneous Coronary Intervention, Primary Prevention, Renal Insufficiency, Risk Factors, Stroke, Systole, Vascular Diseases, Vascular Stiffness
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