Park Hyukjin, Hong Young Joon, Cho Jae Yeong, Sim Doo Sun, Yoon Hyun Ju, Kim Kye Hun, Kim Ju Han, Ahn Youngkeun, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun
Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Korean Circ J. 2017 Jul;47(4):446-454. doi: 10.4070/kcj.2017.0008. Epub 2017 Jul 12.
The optimal blood pressure (BP) target in patients with a history of acute myocardial infarction (MI) remains as a subject of debate. The 'J curve phenomenon' has been suggested as a target for BP control, however, it is unclear whether this phenomenon can be applied to MI patients. We analyzed patients with acute MI and investigated whether the 'J curve phenomenon' exists in this population.
Data were obtained from a nationwide prospective Korea Acute Myocardial Infarction Registry, which included 10337 patients with acute MI who underwent percutaneous coronary intervention (PCI) between 2011 and 2014. The patients were divided into quintiles according to systolic blood pressure (SBP) and diastolic blood pressure (DBP), which were measured during a two-year clinical follow up. Two-year cumulative incidence of major adverse cardiac events (MACE) was analyzed among the groups.
MACE was defined as a composite of cardiac death, need for recurrent revascularization (repeated PCI or coronary arterial bypass graft due to recurrent anginal symptoms or reoccurrence of MI), ischemic cerebrovascular accident, and need for hospitalization due to heart failure. During the two-year follow up, the total cumulative incidence of MACE was 9.7% (n=1005). BP-MACE analysis showed a U-shaped curve for both SBP and DBP, with the lowest MACE rate in quintiles with an average SBP of 112.2 mmHg and DBP of 73.3 mmHg. On Cox regression analysis, the U-shaped relation was statistically significant.
In patients with acute MI, a 'U curve phenomenon' was observed when assessing patient BP control versus MACE rate.
急性心肌梗死（MI）病史患者的最佳血压（BP）目标仍是一个有争议的话题。“J曲线现象”被认为是血压控制的目标，然而，这种现象是否适用于心肌梗死患者尚不清楚。我们分析了急性心肌梗死患者，并调查了该人群中是否存在“J曲线现象”。
数据来自全国性前瞻性韩国急性心肌梗死登记处，其中包括2011年至2014年间接受经皮冠状动脉介入治疗（PCI）的10337例急性心肌梗死患者。根据收缩压（SBP）和舒张压（DBP）将患者分为五等份，这些数据是在两年的临床随访期间测量的。分析了各组主要不良心脏事件（MACE）的两年累积发生率。
MACE定义为心脏死亡、再次血运重建需求（因复发性心绞痛症状或心肌梗死复发而重复进行PCI或冠状动脉旁路移植术）、缺血性脑血管意外以及因心力衰竭住院的综合情况。在两年的随访期间，MACE的总累积发生率为9.7%（n = 1005）。血压-MACE分析显示SBP和DBP均呈U形曲线，平均SBP为112.2 mmHg和DBP为73.3 mmHg的五分位数中MACE发生率最低。在Cox回归分析中，U形关系具有统计学意义。
在急性心肌梗死患者中，评估患者血压控制与MACE发生率时观察到“U曲线现象”。
