Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy.
Am J Cardiol. 2013 Oct 15;112(8):1083-6. doi: 10.1016/j.amjcard.2013.05.053. Epub 2013 Aug 1.
Hypertension is a well-known risk factor for atherosclerosis. However, data on the impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data on patients undergoing primary angioplasty. The aim of the present study was to evaluate the impact of hypertension on distal embolization, myocardial perfusion, and mortality in patients with STEMI undergoing primary percutaneous coronary intervention. Our population is represented by 1,662 patients undergoing primary angioplasty for STEMI included in the Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty database. Myocardial perfusion was evaluated by myocardial blush grade and ST segment resolution. Follow-up data were collected within 1 year after primary angioplasty. Hypertension was observed in 700 patients (42.1%). Hypertension was associated with more advanced age (p <0.001), female gender (p <0.001), diabetes (p <0.001), hypercholesterolemia (p <0.001), previous revascularization (p <0.001), anterior myocardial infarction (p = 0.006), longer ischemia time (p = 0.03), more extensive coronary artery disease (p = 0.002), more often treated with abciximab (p <0.001), and less often smokers (p <0.001). Hypertension was associated with impaired postprocedural myocardial blush grade 2 to 3 (68.2% vs 74.2%, p = 0.019) and complete ST segment resolution (51.7% vs 61.1%, p = 0.001). By a mean follow-up of 206 ± 158 days, 70 patients (4.3%) had died. Hypertension was associated with a greater mortality (6.2% vs 2.9%, hazard ratio 2.31, 95% confidence interval 1.42 to 3.73, p <0.001), confirmed after correction for baseline confounding factors (hazard ratio 1.82, 95% confidence interval 1.03 to 3.22, p <0.001). In conclusion, this study showed that among patients with STEMI undergoing primary angioplasty, hypertension is associated with impaired reperfusion and independently predicts 1-year mortality.
高血压是动脉粥样硬化的一个已知危险因素。然而，关于高血压对 ST 段抬高型心肌梗死（STEMI）患者的影响的数据不一致，主要与溶栓时代的研究有关，而关于接受直接经皮冠状动脉介入治疗（PCI）的患者的数据很少。本研究旨在评估高血压对直接 PCI 治疗的 STEMI 患者远端栓塞、心肌灌注和死亡率的影响。我们的研究人群是纳入 Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty 数据库的 1662 例 STEMI 直接 PCI 患者。心肌灌注通过心肌灌注分级和 ST 段回落来评估。主要终点事件为 1 年随访期内的死亡率。在 700 例（42.1%）患者中观察到高血压。高血压与高龄（p<0.001）、女性（p<0.001）、糖尿病（p<0.001）、高胆固醇血症（p<0.001）、既往血运重建（p<0.001）、前壁心肌梗死（p=0.006）、较长的缺血时间（p=0.03）、更广泛的冠状动脉疾病（p=0.002）、更常接受阿昔单抗治疗（p<0.001）和较少吸烟者（p<0.001）有关。高血压与术后心肌灌注分级 2-3 级（68.2% vs. 74.2%，p=0.019）和完全 ST 段回落（51.7% vs. 61.1%，p=0.001）有关。平均随访 206±158 天后，70 例（4.3%）患者死亡。高血压与更高的死亡率（6.2% vs. 2.9%，风险比 2.31，95%置信区间 1.42-3.73，p<0.001）有关，在对基线混杂因素进行校正后仍然如此（风险比 1.82，95%置信区间 1.03-3.22，p<0.001）。总之，这项研究表明，在接受直接 PCI 的 STEMI 患者中，高血压与再灌注受损有关，并独立预测 1 年死亡率。
