Author + information
- Received January 7, 2019
- Revision received March 6, 2019
- Accepted March 7, 2019
- Published online June 3, 2019.
- Josephine Warren, MBBS, BMedSca,
- Shane Nanayakkara, MBBSa,b,c,
- Nick Andrianopoulos, MBBS, MBiostatd,
- Angela Brennan, RNd,
- Diem Dinh, BAppSc, PhDd,
- Matias Yudi, MBBSe,
- David Clark, MBBS, DMedScie,
- Andrew E. Ajani, MBBS, MDf,
- Christopher M. Reid, PhDd,
- Laura Selkrig, MBBSa,
- James Shaw, MBBS, PhDa,
- Chin Hiew, MBBSg,
- Melanie Freeman, MBBSh,
- David Kaye, MBBS, PhDa,b,c,
- Bronwyn A. Kingwell, PhDb,
- Anthony M. Dart, BM, BCh, DPhila,b,
- Stephen J. Duffy, MBBS, PhDa,b,d,∗ (, )@AlfredHealth,
- on behalf of the Melbourne Interventional Group Investigators
- aAlfred Hospital, Melbourne, Victoria, Australia
- bBaker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- cDepartment of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- dCentre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- eAustin Hospital, Melbourne, Victoria, Australia
- fRoyal Melbourne Hospital, Melbourne, Victoria, Australia
- gGeelong Hospital, Geelong, Victoria, Australia
- hBox Hill Hospital, Melbourne, Victoria, Australia
- ↵∗Address for correspondence:
Dr. Stephen J. Duffy, Heart Centre, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
Background High systolic blood pressure (SBP) increases cardiac afterload, whereas low diastolic blood pressure (DBP) may lead to impaired coronary perfusion. Thus, wide pulse pressure (high systolic, low diastolic [HSLD]) may contribute to myocardial ischemia and also be a predictor of adverse cardiovascular events.
Objectives The purpose of this study was to determine the relationship between pre-procedural blood pressure and long-term outcome following percutaneous coronary intervention (PCI).
Methods The study included 10,876 consecutive patients between August 2009 and December 2016 from the Melbourne Interventional Group registry undergoing PCI with pre-procedural blood pressure recorded. Patients with ST-segment elevation myocardial infarction, cardiogenic shock, and out-of-hospital cardiac arrest were excluded. Patients were divided into 4 groups according to SBP (high ≥120 mm Hg, low <120 mm Hg) and DBP (high >70 mm Hg, low ≤70 mm Hg).
Results Mean pulse pressure was 60 ± 21 mm Hg. Patients with HSLD were older and more frequently women, with higher rates of hypercholesterolemia, renal impairment, diabetes, and multivessel and left main disease (all p ≤ 0.0001). There was no difference in 30-day major adverse cardiac events, but at 12 months the HSLD group had a greater incidence of myocardial infarction (p = 0.018) and stroke (p = 0.013). Long-term mortality was highest for HSLD (7.9%) and lowest for low systolic, high diastolic (narrow pulse pressure) at 2.1% (p = 0.0002). Cox regression analysis demonstrated significantly lower long-term mortality in the low systolic, high diastolic cohort (hazard ratio: 0.50; 99% confidence interval: 0.25 to 0.98; p = 0.04).
Conclusions Pulse pressure at the time of index PCI is associated with long-term outcomes following PCI. A wide pulse pressure may serve as a surrogate marker for risk following PCI and represents a potential target for future therapies.
The Melbourne Interventional Group has received unrestricted educational grant funding from Abbott Vascular, AstraZeneca, Medtronic, Merck Sharp & Dohme, Pfizer, Servier, and The Medicines Company. These companies do not have access to the data, and do not have the right to review manuscripts before publication. Dr Nanayakkara is supported by a Heart Foundation Health Professional Scholarship and a Baker Bright Sparks scholarship. Dr. Yudi is supported by a combined National Health and Medical Research Council and National Heart Foundation Postgraduate Scholarship. Prof. Reid’s and Prof. Duffy’s work is funded by National Health and Medical Research Council of Australia Grants. Dr. Kingwell has research grant contracts with CSL Ltd. that are unrelated to the current publication. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. George Bakris, MD, served as Guest Associate Editor for this paper. A full list of the Melbourne Interventional Group Investigators can be found in the Online Appendix.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received January 7, 2019.
- Revision received March 6, 2019.
- Accepted March 7, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.