De Luca Giuseppe, Dirksen Maurits T, Spaulding Christian, Kelbæk Henning, Schalij Martin, Thuesen Leif, van der Hoeven Bas, Vink Marteen A, Kaiser Christoph, Musto Carmine, Chechi Tania, Spaziani Gaia, Diaz de la Llera Luis Salvador, Pasceri Vincenzo, Di Lorenzo Emilio, Violini Roberto, Suryapranata Harry, Stone Gregg W
Division of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy.
Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Int J Cardiol. 2014 Jul 15;175(1):50-4. doi: 10.1016/j.ijcard.2014.04.180. Epub 2014 Apr 26.
Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic 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 in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES.
Our population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI.
Hypertension was observed in 2764 patients (43.9%), and associated with ageing (p<0.0001), female gender (p<0.001), diabetes (p<0.0001), hypercholesterolemia (p<0.0001), previous MI (p=0.002), previous revascularization (p=0.002), longer time-to-treatment (p<0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p<0.001) and anterior MI (42% vs 45.9%, p=0.002). Hypertension was associated with impaired postprocedural TIMI 0-2 flow (Adjusted OR [95% CI]=1.22 [1.01-1.47], p=0.034). At a follow-up of 1,201 ± 440 days, hypertension was associated with higher mortality (adjusted HR [95% CI]=1.24 [1.01-1.54], p=0.048), reinfarction (adjusted HR [95% CI]=1.31 [1.03-1.66], p=0.027), stent thrombosis (adjusted HR [95% CI]=1.29 [0.98-1.71], p=0.068) and TVR (adjusted HR [95% CI]=1.22 [1.04-1.44], p=0.013).
This study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher ST.
高血压是动脉粥样硬化的一个众所周知的危险因素。然而，关于高血压对ST段抬高型心肌梗死（STEMI）患者预后影响的数据并不一致，且主要与溶栓时代进行的研究相关，接受直接经皮冠状动脉介入治疗（PCI）的患者数据极少。因此，本研究的目的是评估高血压对接受裸金属支架（BMS）或药物洗脱支架（DES）直接PCI的STEMI患者临床结局的影响。
我们的研究人群包括6298例接受直接PCI的STEMI患者，这些患者来自11项比较DES与BMS治疗STEMI的随机试验所纳入的DESERT数据库。
2764例患者（43.9%）存在高血压，且与年龄较大（p<0.0001）、女性（p<0.001）、糖尿病（p<0.0001）、高胆固醇血症（p<0.0001）、既往心肌梗死（p=0.002）、既往血运重建（p=0.002）、较长的治疗时间（p<0.001）、术前心肌梗死溶栓治疗（TIMI）3级血流以及吸烟（41%对53.9%，p<0.001）和前壁心肌梗死（42%对45.9%，p=0.002）患病率较低相关。高血压与术后TIMI 0 - 2级血流受损相关（校正比值比[95%可信区间]=1.22 [1.01 - 1.47]，p=0.034）。在1201±440天的随访中，高血压与较高的死亡率（校正风险比[95%可信区间]=1.24 [1.01 - 1.54]，p=0.048）、再梗死（校正风险比[95%可信区间]=1.31 [1.03 - 1.66]，p=0.027）、支架血栓形成（校正风险比[95%可信区间]=1.29 [0.98 - 1.71]，p=0.068）和靶血管重建（TVR）（校正风险比[95%可信区间]=1.22 [1.04 - 1.44]，p=0.013）相关。
本研究表明，在接受DES或BMS直接PCI的STEMI患者中，高血压与心外膜再灌注受损、死亡率、再梗死和TVR独立相关，且有较高支架血栓形成的趋势。
