Author + information
- Josephine Warren1,
- Shane Nanayakkara1,
- Nick Andrianopoulos2,
- Angela Brennan2,
- Laura Selkrig3,
- Anthony Dart3,
- David Clark4,
- Chin Hiew5,
- Melanie Freeman6,
- Bronwyn Kingwell7 and
- Stephen Duffy1
- 1Alfred Hospital, Melbourne, Victoria, Australia
- 2Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventative Medicine, Monash University, Prahran, Victoria, Australia
- 3Alfred Health, Melbourne, Victoria, Australia
- 4Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
- 5University Hospital, Barwon Health, Geelong, Victoria, Australia
- 6Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia
- 7Baker IDI, Melbourne, Victoria, Australia
Hypertension is a well-established risk factor for coronary artery disease (CAD). However, aggressively lowering diastolic blood pressure (BP) may lead to impaired coronary perfusion and result in myocardial ischemia. Wide pulse pressure (high systolic, low diastolic; HSLD) may also be a predictor of adverse cardiovascular events. We aimed to examine the relationship between blood pressure and risk of major adverse cardiovascular events in patients undergoing percutaneous coronary intervention (PCI).
We studied consecutive patients from the Melbourne Interventional Group registry undergoing PCI with pre-procedural BP recorded. We excluded patients with STEMI, cardiogenic shock and out-of-hospital cardiac arrest. Patients were divided into four groups according to systolic BP (high ≥120mmHg, low <120mmHg) and diastolic BP (high >70mmHg, low ≤70mmHg).
We assessed 10,876 patients across six hospitals between August 2009 and December 2016. Mean systolic BP was 130.2mmHg, mean diastolic BP was 70.4mmHg and mean pulse pressure was 59.7mmHg. Patients with HSLD were older, more frequently female and hypertensive with increased rates of hypercholesterolemia, renal impairment, diabetes and previous CAD (p<0.0001). HSLD patients had more multi-vessel and left main disease on angiogram (p<0.0001). There was no difference in 30-day outcomes, but at 12 months the HSLD group had more myocardial infarction and stroke. National death index linked analysis revealed mortality was highest for HSLD (7.9%) and lowest for low systolic, high diastolic (LSHD; narrow pulse pressure) at 2.1% (p=0.0002). Cox regression analysis showed that having LSHD predicted lower long-term mortality (HR 0.50, 99% CI 0.25-0.98, p=0.04).
Pulse pressure at the time of presentation is associated with long-term outcomes following PCI.
CORONARY: PCI Outcomes