急性左心室心肌梗死患者住院第一周血压与长期死亡率的关联

Association of blood pressure in the first-week of hospitalization and long-term mortality in patients with acute left ventricular myocardial infarction.

作者信息

Tang Yan, Liu Suzhen, Shi Yunming, He Tian, Sun Xuejing, Wu Mingxing, Peng Zhiliu, Gui Fei, Yuan Hong, Lu Yao, Cai Jingjing, Chen Yuanyuan

机构信息

Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China.

Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China.

出版信息

Int J Cardiol. 2022 Feb 15;349:18-26. doi: 10.1016/j.ijcard.2021.11.045. Epub 2021 Nov 24.

DOI:10.1016/j.ijcard.2021.11.045

PMID:34838680

Abstract

BACKGROUND

Previous studies have shown that optimal blood pressure (BP) control is necessary to outcomes in patients with acute myocardial infarction (AMI). Acute left ventricular MI is a prevalent type of AMI with poor prognosis. We aimed to analyze the associations between BP control in the first 7 days of hospitalization and long-term mortality specific to patients with isolated left ventricular MI.

METHODS

A total of 3108 acute left ventricular MI patients were included in this analysis. The average BP on the first seven days of hospitalization was categorized into 10-mmHg increments. The primary and secondary outcomes were all-cause death and cardiac death, respectively. Cox models were used to assess the association of outcomes with BP during hospitalization.

RESULTS

The median length-of-stay was 7 (IQR 6-10) days. The relationship between systolic BP (SBP) or diastolic BP (DBP) followed a U-shaped curve association with outcomes. All-cause mortality was higher in patients with lower SBP (≤90 mmHg) (adjusted hazard ratios (HRs) 7.12, 95% confidence interval (CI) 3.13-16.19; p < 0.001) and DBP (<60 mmHg) (HR 1.76, 95% CI 1.14-2.71; p = 0.011) [reference: 110 < SBP ≤120 mmHg; 70 < DBP ≤ 80 mmHg], respectively. Furthermore, primary outcome was higher in patients with higher SBP (>130 mmHg) (HR 1.51, 95% CI 1.12-2.03; p = 0.007) and DBP (>80 mmHg) (HR 1.61, 95% CI 1.20-2.18; p = 0.002), respectively.

CONCLUSION

Maintaining a SBP from 90 to 130 mmHg and a DBP from 60 to 80 mmHg may be beneficial to patients with acute left ventricular MI in the long run.

摘要

背景

既往研究表明，急性心肌梗死（AMI）患者实现最佳血压（BP）控制对预后至关重要。急性左心室心肌梗死是一种常见的AMI类型，预后较差。我们旨在分析住院第7天的血压控制与孤立性左心室心肌梗死患者长期死亡率之间的关联。

方法

本分析共纳入3108例急性左心室心肌梗死患者。将住院前七天的平均血压按10mmHg的增量进行分类。主要和次要结局分别为全因死亡和心源性死亡。采用Cox模型评估住院期间血压与结局的关联。

结果

中位住院时间为7（IQR 6 - 10）天。收缩压（SBP）或舒张压（DBP）与结局之间呈U形曲线关系。SBP较低（≤90mmHg）（调整后风险比（HRs）7.12，95%置信区间（CI）3.13 - 16.19；p < 0.001）和DBP较低（<60mmHg）（HR 1.76，95% CI 1.14 - 2.71；p = 0.011）的患者全因死亡率较高[参考：110 < SBP ≤ 120mmHg；70 < DBP ≤ 80mmHg]。此外，SBP较高（>130mmHg）（HR 1.51，95% CI 1.12 - 2.03；p = 0.007）和DBP较高（>80mmHg）（HR 1.61，95% CI 1.20 - 2.18；p = 0.002）的患者主要结局发生率较高。