Kim Min, Bae Dae-Hwan, Lee Ju Hee, Lee Dae In, Kim Sang Min, Lee Sang Yeub, Bae Jang-Whan, Kim Dong-Woon, Cho Myeong-Chan, Hwang Jin Yong, Oh Seok Kyu, Cha Kwang Soo, Choi Cheol Ung, Gwon Hyeon Cheol, Jeong Myung Ho, Hwang Kyung-Kuk
Department of Cardiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Cardiol J. 2024;31(1):72-83. doi: 10.5603/CJ.a2022.0067. Epub 2022 Jul 12.
Previous studies demonstrated a J-shaped relationship between low diastolic blood pressure (DBP) and adverse clinical outcomes in patients with acute myocardial infarction (AMI) that was sensitive to revascularization. Hypothesized herein, was that this relationship differs between patients with multivessel disease (MVD) and those with single-vessel disease due to differing degrees of myocardial ischemic burden.
Among 9,983 AMI patients from the Korea Acute Myocardial Infarction Registry database who underwent percutaneous coronary intervention and were followed up for a median duration of 3.2 years, average on-treatment DBP was calculated at admission, discharge, and every scheduled visit and divided into these parameters: < 70 mmHg, 70-74 mmHg, 75-79 mmHg, and ≥ 80 mmHg. The relationship between average on-treatment DBP and clinical outcomes including all-cause death, cardiovascular (CV) death, non-CV death, and hospitalization for heart failure was analyzed using the Cox regression models adjusted for clinical covariates.
In patients with MVD, all-cause death (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.06-2.04, p = 0.012) and CV death (HR: 1.59; 95% CI: 1.02-2.46, p = 0.027) were significantly increased in patients with a DBP < 70 mmHg, showing a J-shaped relationship. However, these findings were not significant for single-vessel disease. On a sensitivity analysis excluding subjects with a baseline SBP < 120 mmHg, an increased risk of a low DBP < 70 mmHg remained in MVD.
The J-shaped relationship between low DBP and adverse clinical outcomes in AMI patients who underwent revascularization persisted in MVD, which has a high ischemic burden. These high-risk patients require cautious treatment.
既往研究表明，急性心肌梗死（AMI）患者中，低舒张压（DBP）与不良临床结局之间呈J形关系，且这种关系对血运重建敏感。本文提出的假设是，由于心肌缺血负担程度不同，多支血管病变（MVD）患者与单支血管病变患者之间的这种关系存在差异。
在韩国急性心肌梗死注册数据库的9983例接受经皮冠状动脉介入治疗且中位随访时间为3.2年的AMI患者中，计算入院时、出院时及每次定期随访时的平均治疗期DBP，并将其分为以下几组：<70 mmHg、70 - 74 mmHg、75 - 79 mmHg和≥80 mmHg。使用针对临床协变量进行调整的Cox回归模型分析平均治疗期DBP与包括全因死亡、心血管（CV）死亡、非CV死亡和心力衰竭住院在内的临床结局之间的关系。
在MVD患者中，DBP<70 mmHg的患者全因死亡（风险比[HR]：1.47；95%置信区间[CI]：1.06 - 2.04，p = 0.012）和CV死亡（HR：1.59；95% CI：1.02 - 2.46，p = 0.027）显著增加，呈J形关系。然而，这些发现对于单支血管病变并不显著。在排除基线收缩压（SBP）<120 mmHg的受试者的敏感性分析中，MVD中DBP<70 mmHg的风险仍然增加。
在缺血负担较高的MVD中，接受血运重建的AMI患者中低DBP与不良临床结局之间的J形关系依然存在。这些高危患者需要谨慎治疗。
