Wang Zijian, Li Xiaoran, Wang Yichun, Bao Boyi, Ding Xiaosong, Li Hongwei, Li Weiping
Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China.
Front Cardiovasc Med. 2022 May 11;9:855602. doi: 10.3389/fcvm.2022.855602. eCollection 2022.
The aim of this study was to assess the effect of pulse pressure (PP) at admission on long-term cardiac and all-cause mortality among elderly patients with type 2 diabetes mellitus (T2DM) admitted for acute coronary syndrome (ACS).
This is a retrospective observational study. The patients aged at least 65 years with T2DM and ACS from January 2013 to April 2018 were enrolled and divided into 4 groups according to admission PP: <50 mmHg; 50-59 mmHg; 60-69 mmHg, and ≥70 mmHg. Multivariate Cox proportional hazard regression analyses and restricted cubic spline were performed to determine the association between PP and outcomes (cardiac and all-cause death).
A total of 2,587 consecutive patients were included in this cohort study. The mean follow-up time was 39.2 months. The incidences of cardiac death and all-cause death were 6.8% ( = 176) and 10.8% ( = 280), respectively. After multivariate adjustment in the whole cohort, cardiac and all-cause mortality were significantly higher in PP <50 mmHg group and PP ≥70 mmHg group, compared with PP 50-59 mmHg group. Further analysis in acute myocardial infarction (AMI) subgroup confirmed that PP <50 mmHg was associated with cardiac death [hazard ratios (HR) 2.92, 95% confidence interval (CI) 1.45-5.76, = 0.002] and all-cause death (HR 2.08, 95% CI 1.20-3.58, = 0.009). Meanwhile, PP ≥70 mmHg was associated with all-cause death (HR 1.78, 95% CI 1.05-3.00, = 0.031). However, admission PP did not appear to be a significant independent predictor in unstable angina pectoris (UAP) subgroup. There is a U-shaped correlation between PP and cardiac and all-cause mortality in the whole cohort and UAP subgroup and a J-shaped correlation in the AMI subgroup, both with a nadir at 50-59 mmHg.
In elderly patients with T2DM admitted for ACS, admission PP is an independent and strong predictor for long-term cardiac and all-cause mortality, especially in patients with AMI.
本研究旨在评估急性冠状动脉综合征（ACS）老年2型糖尿病（T2DM）患者入院时脉压（PP）对长期心脏及全因死亡率的影响。
这是一项回顾性观察性研究。纳入2013年1月至2018年4月年龄≥65岁的T2DM合并ACS患者，并根据入院时PP分为4组：<50 mmHg；50 - 59 mmHg；60 - 69 mmHg和≥70 mmHg。进行多变量Cox比例风险回归分析和限制性立方样条分析以确定PP与结局（心脏及全因死亡）之间的关联。
本队列研究共纳入2587例连续患者。平均随访时间为39.2个月。心脏死亡和全因死亡的发生率分别为6.8%（n = 176）和10.8%（n = 280）。在整个队列进行多变量调整后，与PP 50 - 59 mmHg组相比，PP <50 mmHg组和PP≥70 mmHg组的心脏及全因死亡率显著更高。急性心肌梗死（AMI）亚组的进一步分析证实，PP <50 mmHg与心脏死亡相关[风险比（HR）2.92，95%置信区间（CI）1.45 - 5.76，P = 0.002]和全因死亡（HR 2.08，95% CI 1.20 - 3.58，P = 0.009）。同时，PP≥70 mmHg与全因死亡相关（HR 1.78，95% CI 1.05 - 3.00，P = 0.031）。然而，入院时PP在不稳定型心绞痛（UAP）亚组中似乎不是显著的独立预测因素。在整个队列和UAP亚组中，PP与心脏及全因死亡率呈U形关联，在AMI亚组中呈J形关联，最低点均在50 - 59 mmHg。
在因ACS入院的老年T2DM患者中，入院时PP是长期心脏及全因死亡率的独立且强有力的预测因素，尤其是在AMI患者中。
