Association of blood pressure in the first-week of hospitalization and long-term mortality in patients with acute left ventricular myocardial infarction

Yan Tang; Suzhen Liu; Yunming Shi; Tian He; Xuejing Sun; Mingxing Wu; Zhiliu Peng; Fei Gui; Hong Yuan; Yao Lu; Jingjing Cai; Yuanyuan Chen

doi:10.1016/j.ijcard.2021.11.045

Association of blood pressure in the first-week of hospitalization and long-term mortality in patients with acute left ventricular myocardial infarction

Int J Cardiol. 2022 Feb 15:349:18-26. doi: 10.1016/j.ijcard.2021.11.045. Epub 2021 Nov 24.

Authors

Yan Tang¹, Suzhen Liu¹, Yunming Shi¹, Tian He¹, Xuejing Sun¹, Mingxing Wu², Zhiliu Peng², Fei Gui³, Hong Yuan⁴, Yao Lu⁴, Jingjing Cai⁵, Yuanyuan Chen⁶

Affiliations

¹ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
² Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China.
³ Department of Cardiology, The First Affiliated Hospital, University of South China, Hengyang 421001, China.
⁴ The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
⁵ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China; The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China. Electronic address: caijingjing83@hotmail.com.
⁶ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China. Electronic address: 208311012@csu.edu.cn.

PMID: 34838680
DOI: 10.1016/j.ijcard.2021.11.045

Abstract

Background: Previous studies have shown that optimal blood pressure (BP) control is necessary to outcomes in patients with acute myocardial infarction (AMI). Acute left ventricular MI is a prevalent type of AMI with poor prognosis. We aimed to analyze the associations between BP control in the first 7 days of hospitalization and long-term mortality specific to patients with isolated left ventricular MI.

Methods: A total of 3108 acute left ventricular MI patients were included in this analysis. The average BP on the first seven days of hospitalization was categorized into 10-mmHg increments. The primary and secondary outcomes were all-cause death and cardiac death, respectively. Cox models were used to assess the association of outcomes with BP during hospitalization.

Results: The median length-of-stay was 7 (IQR 6-10) days. The relationship between systolic BP (SBP) or diastolic BP (DBP) followed a U-shaped curve association with outcomes. All-cause mortality was higher in patients with lower SBP (≤90 mmHg) (adjusted hazard ratios (HRs) 7.12, 95% confidence interval (CI) 3.13-16.19; p < 0.001) and DBP (<60 mmHg) (HR 1.76, 95% CI 1.14-2.71; p = 0.011) [reference: 110 < SBP ≤120 mmHg; 70 < DBP ≤ 80 mmHg], respectively. Furthermore, primary outcome was higher in patients with higher SBP (>130 mmHg) (HR 1.51, 95% CI 1.12-2.03; p = 0.007) and DBP (>80 mmHg) (HR 1.61, 95% CI 1.20-2.18; p = 0.002), respectively.

Conclusion: Maintaining a SBP from 90 to 130 mmHg and a DBP from 60 to 80 mmHg may be beneficial to patients with acute left ventricular MI in the long run.

Keywords: Acute myocardial infarction; Blood pressure; Left ventricle; Prognosis.

MeSH terms

Blood Pressure
Hospitalization
Humans
Hypertension*
Myocardial Infarction* / diagnosis
Myocardial Infarction* / therapy
Risk Factors
Stroke*