Park Se-Jun, Son Jung-Woo, Hong Kyung-Soon, Choi Hyun-Hee
Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
Department of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
J Cardiol. 2020 Jun;75(6):648-653. doi: 10.1016/j.jjcc.2019.12.014. Epub 2020 Feb 7.
We investigated the effect of inter-arm blood pressure differences (IABPD) on the percutaneous coronary intervention (PCI) outcomes of patients with coronary artery diseases.
We retrospectively reviewed the data of blood pressures measured simultaneously in the bilateral arms of 855 patients (560 males) who underwent PCI with drug-eluting stents for coronary artery diseases. IABPD was defined as the difference of blood pressure in both arms. The primary outcome was the presence of major adverse cardiac events (MACE) consisting of cardiovascular death, myocardial infarction, stroke, and ischemia-driven target vessel revascularization.
The mean age of the included patients was 66.2 ± 11.6 years, with a mean follow-up period of 44.5 ± 26.4 months. MACE occurred in 15.2% of patients, showing a higher rate in the higher IABPD group (≥10 mmHg) than in the lower IABPD group (<10 mmHg) (22.5% vs 14.5%, p = 0.081). The difference was induced by a higher rate of ischemia-driven target vessel revascularization (17.5% vs 8.3%, p = 0.011). The Kaplan-Meier survival analysis revealed a greater incidence of MACE in patients with a higher IABPD (log rank p = 0.054). The Cox proportional hazard analysis showed that IABPD was an independent predictor of long-term MACE (hazard ratio, 1.028; 95% confidence interval, 1.002-1.055; p = 0.037), along with age, diabetes mellitus, and number of implanted stents.
Among patients treated with PCI, the incidence of MACE was significantly higher in those with a higher IABPD (≥10 mmHg) than in those with a lower IABPD (<10 mmHg), which was mainly driven by ischemia-driven target vessel revascularization.
我们研究了双臂血压差异（IABPD）对冠状动脉疾病患者经皮冠状动脉介入治疗（PCI）结果的影响。
我们回顾性分析了855例（560例男性）接受药物洗脱支架PCI治疗冠状动脉疾病患者双侧手臂同时测量的血压数据。IABPD定义为双臂血压之差。主要结局是主要不良心脏事件（MACE）的发生，包括心血管死亡、心肌梗死、中风和缺血驱动的靶血管血运重建。
纳入患者的平均年龄为66.2±11.6岁，平均随访期为44.5±26.4个月。15.2%的患者发生了MACE，IABPD较高组（≥10 mmHg）的发生率高于IABPD较低组（<10 mmHg）（22.5%对14.5%，p = 0.081）。这种差异是由缺血驱动的靶血管血运重建率较高引起的（17.5%对8.3%，p = 0.011）。Kaplan-Meier生存分析显示，IABPD较高的患者发生MACE的发生率更高（对数秩检验p = 0.054）。Cox比例风险分析表明，IABPD是长期MACE的独立预测因素（风险比，1.028；95%置信区间，1.002 - 1.055；p = 0.037），与年龄、糖尿病和植入支架数量有关。
在接受PCI治疗的患者中，IABPD较高（≥10 mmHg）的患者发生MACE的发生率显著高于IABPD较低（<10 mmHg）的患者，这主要是由缺血驱动的靶血管血运重建引起的。
