Shiraishi Jun, Kohno Yoshio, Sawada Takahisa, Hashimoto Sho, Ito Daisuke, Kimura Masayoshi, Matsui Akihiro, Yokoi Hirokazu, Arihara Masayasu, Irie Hidekazu, Hyogo Masayuki, Shima Takatomo, Nakamura Takeshi, Matoba Satoaki, Yamada Hiroyuki, Matsumuro Akiyoshi, Shirayama Takeshi, Kitamura Makoto, Furukawa Keizo, Matsubara Hiroaki
Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan.
Heart Vessels. 2013 Jul;28(4):434-41. doi: 10.1007/s00380-012-0277-y. Epub 2012 Aug 28.
Data regarding relationship between pulse pressure (PP) at admission and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still lacking. A total of 1413 primary PCI-treated AMI patients were classified into quintiles based on admission PP (<40, n = 280; 40-48, n = 276; 49-57, n = 288; 58-70, n = 288; and ≥71 mmHg, n = 281). The patients with PP < 40 mmHg tended to have higher prevalence of male, smoking, and Killip class ≥3 at admission; right coronary artery, left main trunk (LMT), or multivessels as culprit lesions; larger number of diseased vessels; lower Thrombolysis in Myocardial Infarction (TIMI) grade in the infarct-related artery before/after primary PCI; and higher value of peak creatine phosphokinase concentration. Patients with PP < 40 mmHg had highest mortality, while patients with PP 49-57 mmHg had the lowest: 11.8 % (<40), 7.2 % (40-48), 2.8 % (49-57), 5.9 % (58-70), and 6.0 % (≥71 mmHg). On multivariate analysis, Killip class ≥3 at admission, LMT or multivessels as culprit lesions, chronic kidney disease, and age were the independent positive predictors of the in-hospital mortality, whereas admission PP 49-57 mmHg, hypercholesterolemia, and TIMI 3 flow before/after PCI were the negative ones, but admission PP < 40 mmHg was not. These results suggest that admission PP 49-57 mmHg might be correlated with better in-hospital prognosis in Japanese AMI patients undergoing primary PCI.
关于接受直接经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者入院时脉压（PP）与院内结局之间关系的数据仍然缺乏。总共1413例接受直接PCI治疗的AMI患者根据入院时的PP分为五分位数（<40，n = 280；40 - 48，n = 276；49 - 57，n = 288；58 - 70，n = 288；≥71 mmHg，n = 281）。PP < 40 mmHg的患者在入院时男性、吸烟和Killip分级≥3的患病率往往更高；右冠状动脉、左主干（LMT）或多支血管作为罪犯病变；病变血管数量更多；直接PCI前后梗死相关动脉的心肌梗死溶栓（TIMI）分级更低；以及肌酸磷酸激酶峰值浓度更高。PP < 40 mmHg的患者死亡率最高，而PP为49 - 57 mmHg的患者死亡率最低：11.8%（<40），7.2%（40 - 48），2.8%（49 - 57），5.9%（58 - 70）和6.0%（≥71 mmHg）。多因素分析显示，入院时Killip分级≥3、LMT或多支血管作为罪犯病变、慢性肾脏病和年龄是院内死亡的独立阳性预测因素，而入院时PP为49 - 57 mmHg、高胆固醇血症以及PCI前后TIMI 3级血流是阴性预测因素，但入院时PP < 40 mmHg不是。这些结果表明，入院时PP为49 - 57 mmHg可能与接受直接PCI的日本AMI患者更好的院内预后相关。
