Huang Bi, Yang Yanmin, Zhu Jun, Liang Yan, Tan Huiqiong
State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
BMJ Open. 2014 Jun 13;4(6):e005097. doi: 10.1136/bmjopen-2014-005097.
Prognostic value of lower admission systolic blood pressure (SBP) in patients with acute myocardial infarction has been confirmed, but the impact of elevated admission SBP on short-term outcomes has been evaluated only by a limited number of studies and they have reported conflicting results. The aim of our study was to investigate the characteristics and short-term outcomes in patients with elevated admission SBP after ST-elevation myocardial infarction (STEMI).
A population-based, observational study.
The multicentre registry in China.
A total of 7510 consecutive patients with STEMI were registered. Patients were divided into three groups according to admission SBP: normal admission SBP (100-139 mm Hg), modestly elevated admission SBP (140-179 mm Hg) and excessively elevated admission SBP (≥180 mm Hg). The primary outcomes were 7-day and 30-day all-cause mortality, major adverse cardiac events (MACE) and bleeding rate.
Of 6591 patients, 4182 (63.5%) had normal admission SBP, 2187 (33.2%) modestly elevated admission SBP and 222 (3.4%) excessively elevated admission SBP. Patients with elevated admission SBP had a high-risk profile, such as were more likely to be older, with more concomitant cardiovascular morbidities, presenting with more events of anterior myocardial infarction and less reperfusion treatment. However, 7-day and 30-day all-cause mortality, MACE and bleeding rate were comparable among groups (all p>0.05). Survival curves and MACE curves were similar among groups (p=0.377 and 0.375, respectively). After multivariate adjustment, elevated admission SBP was not associated with increased risk of short-term death and bleeding, and MACE was comparable with normal admission SBP.
Although those with elevated admission SBP after STEMI were at a higher risk for cardiovascular events, they did not have poorer short-term outcomes compared with patients with normal admission SBP.
急性心肌梗死患者入院时较低的收缩压（SBP）的预后价值已得到证实，但入院时SBP升高对短期预后的影响仅通过少数研究进行了评估，且这些研究报告的结果相互矛盾。我们研究的目的是调查ST段抬高型心肌梗死（STEMI）后入院时SBP升高患者的特征和短期预后。
一项基于人群的观察性研究。
中国的多中心注册研究。
共纳入7510例连续的STEMI患者。根据入院时SBP将患者分为三组：入院时SBP正常（100 - 139 mmHg）、入院时SBP轻度升高（140 - 179 mmHg）和入院时SBP极度升高（≥180 mmHg）。主要结局为7天和30天全因死亡率、主要不良心血管事件（MACE）和出血率。
在6591例患者中，4182例（63.5%）入院时SBP正常，2187例（33.2%）入院时SBP轻度升高，222例（3.4%）入院时SBP极度升高。入院时SBP升高的患者具有高危特征，例如更可能年龄较大，合并更多心血管疾病，发生前壁心肌梗死事件更多，再灌注治疗更少。然而，各组间7天和30天全因死亡率、MACE和出血率相当（均p>0.05）。各组间生存曲线和MACE曲线相似（分别为p = 0.377和0.375）。多因素调整后，入院时SBP升高与短期死亡和出血风险增加无关，且MACE与入院时SBP正常者相当。
虽然STEMI后入院时SBP升高的患者发生心血管事件的风险较高，但与入院时SBP正常的患者相比，他们的短期预后并不更差。
