ST 段抬高型心肌梗死患者经皮冠状动脉介入治疗后的高血压、微血管阻塞和梗死面积：7 项心脏磁共振成像研究的汇总分析。

Hypertension, microvascular obstruction and infarct size in patients with STEMI undergoing PCI: Pooled analysis from 7 cardiac magnetic resonance imaging studies.

机构信息

Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY.

Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.

出版信息

Am Heart J. 2024 May;271:148-155. doi: 10.1016/j.ahj.2024.02.023. Epub 2024 Mar 1.

DOI:10.1016/j.ahj.2024.02.023

PMID:38430992

Abstract

BACKGROUND

Mortality after ST-segment elevation myocardial infarction (STEMI) is increased in patients with hypertension. The mechanisms underlying this association are uncertain. We sought to investigate whether patients with STEMI and prior hypertension have greater microvascular obstruction (MVO) and infarct size (IS) compared with those without hypertension.

METHODS

We pooled individual patient data from 7 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) in whom cardiac magnetic resonance imaging was performed within 1 month after reperfusion. The associations between hypertension and MVO, IS, and mortality were assessed in multivariable adjusted models.

RESULTS

Among 2174 patients (61.3 ± 12.6 years, 76% male), 1196 (55.0%) had hypertension. Patients with hypertension were older, more frequently diabetic and had more extensive coronary artery disease than those without hypertension. MVO and IS measured as percent LV mass were not significantly different in patients with and without hypertension (adjusted differences 0.1, 95% CI -0.3 to 0.6, P = .61 and -0.2, 95% CI -1.5 to 1.2, P = .80, respectively). Hypertension was associated with a higher unadjusted risk of 1-year death (hazard ratio [HR] 2.28, 95% CI 1.44-3.60, P < .001), but was not independently associated with higher mortality after multivariable adjustment (adjusted HR 1.04, 95% CI 0.60-1.79, P = .90).

CONCLUSION

In this large-scale individual patient data pooled analysis, hypertension was not associated with larger IS or MVO after primary PCI for STEMI.

摘要

背景

患有高血压的 ST 段抬高型心肌梗死（STEMI）患者的死亡率增加。这种关联的机制尚不清楚。我们试图研究患有 STEMI 和既往高血压的患者与没有高血压的患者相比，是否存在更大的微血管阻塞（MVO）和梗死面积（IS）。

方法

我们汇总了 7 项随机试验的个体患者数据，这些试验纳入了接受直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者，在再灌注后 1 个月内进行了心脏磁共振成像。在多变量调整模型中评估了高血压与 MVO、IS 和死亡率之间的关联。

结果

在 2174 例患者（61.3 ± 12.6 岁，76%为男性）中，有 1196 例（55.0%）患有高血压。与无高血压的患者相比，高血压患者年龄更大，更常患有糖尿病，且冠状动脉疾病更为广泛。按左心室质量百分比测量的 MVO 和 IS 无显著差异（调整后的差异分别为 0.1%，95%CI-0.3 至 0.6%，P =.61 和-0.2%，95%CI-1.5 至 1.2%，P =.80）。未经调整的 1 年死亡率，高血压患者的风险更高（危险比[HR] 2.28，95%CI 1.44-3.60，P <.001），但在多变量调整后，高血压与死亡率升高无关（调整后的 HR 1.04，95%CI 0.60-1.79，P =.90）。