Department of Cardiology, Gulhane Military Medical Academy Haydarpasa Education Hospital, Istanbul, Turkey.
Atherosclerosis. 2011 Dec;219(2):951-7. doi: 10.1016/j.atherosclerosis.2011.09.039. Epub 2011 Oct 2.
Previous studies have showed that BP variability is associated with cardiovascular events. However, no data were available regarding binary restenosis as an end-point after percutenous coronary intervention (PCI).
This multicenter study included 100 consecutive normotensive patients with stable coronary artery disease who were planned for PCI. Before the index procedure, office BP and 24-h ambulatory BP measurements were performed. BP variability indices including systolic and diastolic 24-h average, the day and the night values of standard deviation (SD) and variation coefficient (VC) were measured and calculated. All patients underwent repeat coronary angiography at 6-month. According to angiographic results, 2 groups were formed; a restenosis group (n=30) with binary restenosis of the stented segment and a control group (n=70) with a stenosis diameter of <50% in stented segment. Systolic SD and VC values for 24-h average (14.0±2.8mmHg vs. 9.5±1.6mmHg, p<0.001 and 16%±3 vs. 11%±2, p<0.001, respectively), the day (15.2±3.9mmHg vs. 10.6±1.7mmHg, p<0.001 and 17%±4 vs. 12%±2, p<0.001, respectively), and the night (12.8±4.1mmHg vs. 8.4±2.4mmHg, p<0.001 and 14%±5 vs. 11%±3, p=0.004, respectively) values were significantly higher in restenosis group compared to control group. Similarly, diastolic SD and VC values for 24-h average (10.6±2.5mmHg vs. 8.1±1.5mmHg, p<0.001 and 12%±3 vs. 9%±2, p=0.001, respectively), the day (11.1±2.9mmHg vs. 9.0±1.8mmHg, p=0.003 and 12%±3 vs. 10%±2, p=0.006, respectively), and the night (10.0±3.6mmHg vs. 7.2±2.0mmHg, p=0.001 and 11%±5 vs. 9%±3, p=0.059, respectively) values were significantly higher in restenosis group compared to no restenosis group except for diastolic VC night. All systolic and diastolic BP variability indices except diastolic VC night were found to be independent predictors of risk of restenosis in multivariate analysis. In addition, the cut-off values of 11.4mmHg and 13% for 24-h systolic SD and VC, respectively, were found to be highly sensitive (93% for both) and specific (94% and 91%, respectively) for predicting binary restenosis at 6-month after PCI.
BP variability indices are significantly and independently associated with binary restenosis and higher values can predict restenosis after PCI sensitively and specifically.
先前的研究表明，血压变异性与心血管事件有关。然而，在经皮冠状动脉介入治疗（PCI）后，作为终点的二元再狭窄方面尚无相关数据。
本多中心研究纳入了 100 例计划接受 PCI 的稳定型冠状动脉疾病的连续正常血压患者。在指数操作之前，进行了办公室血压和 24 小时动态血压测量。测量并计算了包括收缩压和舒张压 24 小时平均、白天和夜间标准差（SD）和变异系数（VC）的血压变异性指数。所有患者均在 6 个月时进行重复冠状动脉造影。根据血管造影结果，将患者分为两组；再狭窄组（n=30）为支架段出现二元再狭窄，对照组（n=70）为支架段狭窄程度<50%。24 小时平均（14.0±2.8mmHg 与 9.5±1.6mmHg，p<0.001 和 16%±3 与 11%±2，p<0.001）、白天（15.2±3.9mmHg 与 10.6±1.7mmHg，p<0.001 和 17%±4 与 12%±2，p<0.001）和夜间（12.8±4.1mmHg 与 8.4±2.4mmHg，p<0.001 和 14%±5 与 11%±3，p=0.004）的收缩压 SD 和 VC 值在再狭窄组中显著更高。同样，24 小时平均（10.6±2.5mmHg 与 8.1±1.5mmHg，p<0.001 和 12%±3 与 9%±2，p=0.001）、白天（11.1±2.9mmHg 与 9.0±1.8mmHg，p=0.003 和 12%±3 与 10%±2，p=0.006）和夜间（10.0±3.6mmHg 与 7.2±2.0mmHg，p=0.001 和 11%±5 与 9%±3，p=0.059）的舒张压 SD 和 VC 值在再狭窄组中也显著更高，除了夜间舒张压 VC 之外。多元分析发现，所有收缩压和舒张压血压变异性指数（除了夜间舒张压 VC）都是再狭窄的独立预测因子。此外，发现 24 小时收缩压 SD 的 11.4mmHg 和 VC 的 13%的截断值对 PCI 后 6 个月的二元再狭窄具有高度敏感性（均为 93%）和特异性（分别为 94%和 91%）。
血压变异性指数与二元再狭窄显著相关，并且较高的数值可以敏感且特异性地预测 PCI 后的再狭窄。
