Ndrepepa Gjin, Cassese Salvatore, Kufner Sebastian, Xhepa Erion, Fusaro Massimiliano, Laugwitz Karl-Ludwig, Schunkert Heribert, Kastrati Adnan
Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Lazarettstrasse 36, 80636, Munich, Germany.
I. Medizinische Klinik, Klinikum Rechts Der Isar, Technische Universität, Munich, Germany.
Heart Vessels. 2019 Jul;34(7):1104-1112. doi: 10.1007/s00380-019-01344-x. Epub 2019 Jan 22.
The relationship between central pulse pressure (CPP) measured at the time of primary percutaneous coronary intervention (PPCI) and long-term prognosis after ST-segment elevation myocardial infarction (STEMI) has not been investigated. CPP measurements were performed in 1348 patients with STEMI (327 women; mean age 62.5 ± 12.1 years) undergoing PPCI. Aortic systolic and diastolic blood pressure was measured before intervention. The primary outcome was 8-year all-cause mortality. The median [25-75th percentile] CPP value was 55.0 [43.0-70.0] mmHg. CPP correlated negatively with heart rate (P < 0.001), body mass index (P = 0.007), Killip class (P < 0.001) and initial area at risk (P < 0.001) and positively with age (P < 0.001), female sex (P < 0.001), diabetes (P = 0.012), arterial hypertension (P < 0.001) and glomerular filtration rate (P = 0.004). There were 181 deaths over the follow-up. In patients with CPP within the 1st, 2nd and 3rd tertiles, the Kaplan-Meier estimates of mortality were 17.3%, 10.8% and 24.2%, respectively; univariable hazard ratio [HR] =1.52, 95% confidence interval [CI] 0.99 to 2.32; P = 0.055 for tertile 1 vs. tertile 2 and HR =2.09 [1.36-3.21]; P < 0.001 for tertile 3 vs. tertile 2. For CPP values lower than 35 mmHg and higher than 71 mmHg, the association between CPP and all-cause mortality was significant (HR =1.276 [1.004-1.621] for the 35 mmHg value and HR =1.289 [1.003-1.657] for the 71 mmHg value) compared with the CPP reference value (54 mmHg). After adjustment, the association between CPP and all-cause mortality was attenuated (P = 0.304). In patients with STEMI undergoing PPCI there is a U-shaped association between CPP and mortality up to 8 years after PPCI.
在接受直接经皮冠状动脉介入治疗（PPCI）时测量的中心脉压（CPP）与ST段抬高型心肌梗死（STEMI）后的长期预后之间的关系尚未得到研究。对1348例接受PPCI的STEMI患者（327例女性；平均年龄62.5±12.1岁）进行了CPP测量。在干预前测量主动脉收缩压和舒张压。主要结局为8年全因死亡率。CPP的中位数[第25 - 75百分位数]为55.0[43.0 - 70.0]mmHg。CPP与心率（P<0.001）、体重指数（P = 0.007）、Killip分级（P<0.001）和初始危险面积（P<0.001）呈负相关，与年龄（P<0.001）、女性（P<0.001）、糖尿病（P = 0.012）、动脉高血压（P<0.001）和肾小球滤过率（P = 0.004）呈正相关。随访期间有181例死亡。在CPP处于第1、第2和第3三分位数的患者中，Kaplan-Meier法估计的死亡率分别为17.3%、10.8%和24.2%；单变量风险比[HR]=1.52，95%置信区间[CI]为0.99至2.32；第1三分位数与第2三分位数相比，P = 0.055，HR = 2.09[1.36 - 3.21]；第3三分位数与第2三分位数相比，P<0.001。对于低于35mmHg和高于71mmHg的CPP值，与CPP参考值（54mmHg）相比，CPP与全因死亡率之间的关联具有显著性（35mmHg值时HR = 1.276[1.004 - 1.621]，71mmHg值时HR = 1.289[1.003 - 1.657]）。调整后，CPP与全因死亡率之间的关联减弱（P = 0.304）。在接受PPCI的STEMI患者中，PPCI后长达8年，CPP与死亡率之间存在U型关联。
