Department of Cardiology, The Heart Center, Zhe Jiang Hospital, Hangzhou, 310012, People's Republic of China.
Psychiatry Department, Fuyang District Third People's Hospital, Hangzhou, 311400, People's Republic of China.
Clin Interv Aging. 2024 Mar 23;19:571-579. doi: 10.2147/CIA.S449905. eCollection 2024.
Rate-pressure product (RPP) calculated by multiplying heart rate by systolic blood pressure, is a convenient indicator closely associated with cardiac work or myocardial oxygen consumption. It has been reported to relate strongly to important indices of cardiovascular risk in patients with myocardial ischemia. However, its relationship with short- and long-term mortality in patients with acute coronary syndrome (ACS) undergoing primary PCI/immediate invasive strategy has not been defined.
This study analyzed 1301 consecutive ACS patients who had undergone primary PCI, between January 2018 and September 2021. Patients with systolic BP < 90 mmHg were excluded to avoid the confounding effect of cardiogenic shock. RPP values were collected on admission and were divided into four groups: RPP ≤ 7.4, 7.4 ≤ 8.8, 8.8 <8.8 < RPP8, and RPP > 10.8. Clinical endpoints were in-hospital cardiac and long-term all-cause mortality. The predictive performance was assessed by C-statistic, multivariate analysis and survival analysis.
Multivariate analysis showed that these in the highest vs lowest category of RPP (>10.8 vs ≤7.4) had OR of 4.33 (95% CI=1.10 -17.01; P = 0.036) in in-hospital cardiac mortality and 3.15 (95% CI=1.24 -8.00; P = 0.016) in long-term all-cause mortality. In C-statistic analyses, RPP was a strong predictor in ACS, STEMI or UA/NSTEMI group for in-hospital cardiac mortality (AUC = 0.746, 95% CI = 0.722-0.770, p < 0.001) and long-term all-cause mortality (AUC = 0.701, 95% CI = 0.675-0.725, p < 0.001). The Kaplan-Meier event rate for long-term survival of RPP > 10.8 was significantly lower than that of RPP ≤ 10.8.
RPP showed a positive association with in-hospital cardiac or long-term all-cause mortality in ACS patients undergoing primary PCI/immediate invasive strategy, and RPP > 10.8 can be as an independent predictor.
心率与收缩压相乘得到的速率-压力产物（RPP）是一个与心脏做功或心肌耗氧量密切相关的便捷指标。已有研究报道，它与心肌缺血患者的心血管风险的重要指标密切相关。然而，在接受直接经皮冠状动脉介入治疗/即刻侵入性策略的急性冠状动脉综合征（ACS）患者中，RPP 与短期和长期死亡率之间的关系尚未明确。
本研究分析了 2018 年 1 月至 2021 年 9 月期间接受直接经皮冠状动脉介入治疗的 1301 例连续 ACS 患者。排除收缩压 < 90mmHg 的患者，以避免心源性休克的混杂影响。入院时收集 RPP 值，并将其分为四组：RPP ≤ 7.4、7.4 ≤ 8.8、8.8 < RPP < 8.8 和 RPP > 10.8。临床终点为院内心源性死亡和长期全因死亡率。通过 C 统计量、多变量分析和生存分析评估预测性能。
多变量分析显示，与最低 RPP 组（≤7.4）相比，最高 RPP 组（>10.8）的院内心源性死亡率的比值比（OR）为 4.33（95%CI=1.10-17.01；P=0.036），长期全因死亡率的 OR 为 3.15（95%CI=1.24-8.00；P=0.016）。在 C 统计量分析中，RPP 是 ACS、ST 段抬高型心肌梗死（STEMI）或非 ST 段抬高型心肌梗死（UA/NSTEMI）患者院内心源性死亡率（AUC=0.746，95%CI=0.722-0.770，p<0.001）和长期全因死亡率（AUC=0.701，95%CI=0.675-0.725，p<0.001）的有力预测指标。RPP>10.8 的患者长期生存的 Kaplan-Meier 事件发生率明显低于 RPP≤10.8 的患者。
RPP 与直接经皮冠状动脉介入治疗/即刻侵入性策略治疗的 ACS 患者的院内心源性或长期全因死亡率呈正相关，RPP>10.8 可作为独立预测指标。
