Clinical Research Initiative, Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, Scotland, UK.
Clin Res Cardiol. 2012 Jan;101(1):29-35. doi: 10.1007/s00392-011-0360-x. Epub 2011 Sep 21.
In patients with cardiovascular disease, a high pulse pressure is related to an increased risk of cardiovascular events but in patients with advanced heart failure, a low pulse pressure is predictive of adverse (cardiovascular) events.
We studied the prognostic importance of pulse pressure in a group of post-myocardial infarction patients, with and without signs and symptoms of heart failure. Subjects had been randomised in the CAPRICORN clinical trial, and followed up for a mean of 1.3 years.
Blood pressure was measured in 1,955 patients with a left ventricular ejection fraction ≤40%, between 3 and 21 days post myocardial infarction. Cox proportional survival models were reproduced for those with Killip Class I (n = 1342) versus classes II/III/IV heart failure (n = 613).
Overall mean (SD) age was 63 (12) years, mean (SD) left ventricular ejection fraction 33(6)%, mean (SD) baseline blood pressure was 121 (17)/74 (10) mmHg and most (73%) were male. In patients with Killip Class 1, pulse pressure was not predictive for any outcome. However, in patients with Killip Class II-IV, a low pulse pressure independently predicted all cause mortality (HR 0.83 per 10 mmHg, CI 0.71-0.98, p = 0.025), cardiovascular mortality (HR 0.83 per 10 mmHg, CI 0.70-0.98, p = 0.025) and sudden death (HR 0.77 per 10 mmHg, CI 0.60-1.00, p = 0.047). A lower pulse pressure did not predict hospitalisation for worsening heart failure.
A low pulse pressure is an independent predictor of mortality in subjects with depressed left ventricular ejection fraction after a recent myocardial infarction and evidence of Killip Class II-IV heart failure.
在心血管疾病患者中，脉压升高与心血管事件风险增加相关，但在晚期心力衰竭患者中，脉压降低预示着不良（心血管）事件。
我们研究了一组心肌梗死后患者的脉压预后重要性，这些患者有或没有心力衰竭的症状和体征。这些患者在 CAPRICORN 临床试验中被随机分组，平均随访 1.3 年。
对左心室射血分数（LVEF）≤40%的 1955 例患者在心肌梗死后 3 至 21 天内测量血压。采用 Cox 比例生存模型对 Killip 分级 I（n = 1342）与 II/III/IV 级心力衰竭（n = 613）患者进行复制。
总体平均（SD）年龄为 63（12）岁，平均（SD）LVEF 为 33（6）%，平均（SD）基线血压为 121（17）/74（10）mmHg，大多数（73%）为男性。在 Killip 分级 I 的患者中，脉压不能预测任何结局。然而，在 Killip 分级 II-IV 的患者中，低脉压独立预测全因死亡率（每降低 10mmHg 的 HR 为 0.83，95%CI 为 0.71-0.98，p = 0.025）、心血管死亡率（每降低 10mmHg 的 HR 为 0.83，95%CI 为 0.70-0.98，p = 0.025）和猝死（每降低 10mmHg 的 HR 为 0.77，95%CI 为 0.60-1.00，p = 0.047）。较低的脉压不能预测心力衰竭恶化的住院率。
在近期心肌梗死后 LVEF 降低且存在 Killip II-IV 级心力衰竭的患者中，脉压降低是死亡率的独立预测因素。
