Nochioka Kotaro, Nakayama Masaharu, Akashi Naoyuki, Matoba Tetsuya, Kohro Takahide, Oba Yusuke, Kabutoya Tomoyuki, Imai Yasushi, Kario Kazuomi, Kiyosue Arihiro, Mizuno Yoshiko, Iwai Takamasa, Miyamoto Yoshihiro, Ishii Masanobu, Nakamura Taishi, Tsujita Kenichi, Sato Hisahiko, Fujita Hideo, Nagai Ryozo
Division of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1, Aoba-ku, Sendai 981-0933, Japan.
Department of Medical Informatics, Tohoku University Graduate School of Medicine, 1-1-1 Seiryo-machi, Aoba-ku, Sendai 981-0933, Japan.
Int J Cardiol Heart Vasc. 2024 May 24;53:101430. doi: 10.1016/j.ijcha.2024.101430. eCollection 2024 Aug.
Limited data exist on the prognostic value of changes in pulse pressure (PP, the difference between systolic and diastolic blood pressure) during hospitalization for patients with coronary artery disease who have undergone percutaneous coronary intervention (PCI).
In the Clinical Deep Data Accumulation System (CLIDAS), we studied 8,708 patients who underwent PCI. We aimed to examine the association between discharge PP and cardiovascular outcomes. PP was measured before PCI and at discharge. Patients were divided into five groups (quintiles) based on the change in PPQ1 (-18.0 ± 9.9 mmHg), Q2 (-3.8 ± 2.6), Q3 (reference; 3.7 ± 2.0), Q4 (11.3 ± 2.6), and Q5 (27.5 ± 11.2). We then analyzed the relationship between PP change and outcomes.
The mean patient age was 70 ± 11 years, with 6,851 (78 %) men and 3,786 (43 %) having acute coronary syndrome. U-shaped relationships were observed for the incidence rates of major adverse cardiac or cerebrovascular events (MACCE, a composite endpoint of cardiovascular death, myocardial infarction, and stroke), revascularization, and hospitalization for heart failure (HF). After adjusting for confounding factors, higher PP at discharge was associated with an increased risk of MACCE (adjusted hazard ratio 1.41; 95 %CI, 1.06-1.87 in Q5 [73.9 ± 9.3 mmHg]). Evaluating PP change revealed a U-shaped association with MACCE (1.50; 1.11-2.02 in Q1 and 1.47; 0.98-2.20 in Q5). Additionally, Q5 had a higher risk for hospitalization for HF (1.37; 1.00-1.88).
Our findings demonstrate a U-shaped association between changes in PP and cardiovascular outcomes. This data suggests the significance of blood pressure control during hospitalization for patients who have undergone PCI.
对于接受经皮冠状动脉介入治疗（PCI）的冠心病患者，住院期间脉压（PP，收缩压与舒张压之差）变化的预后价值相关数据有限。
在临床深度数据积累系统（CLIDAS）中，我们研究了8708例接受PCI的患者。我们旨在研究出院时PP与心血管结局之间的关联。在PCI术前和出院时测量PP。根据PP变化将患者分为五组（五分位数）：Q1（-18.0±9.9mmHg）、Q2（-3.8±2.6）、Q3（参考组；3.7±2.0）、Q4（11.3±2.6）和Q5（27.5±11.2）。然后我们分析了PP变化与结局之间的关系。
患者平均年龄为70±11岁，其中6851例（78%）为男性，3786例（43%）患有急性冠状动脉综合征。观察到主要不良心脏或脑血管事件（MACCE，心血管死亡、心肌梗死和中风的复合终点）、血运重建和心力衰竭（HF）住院发生率呈U形关系。在调整混杂因素后，出院时较高的PP与MACCE风险增加相关（Q5[73.9±9.3mmHg]时调整后风险比为1.41；95%CI，1.06-1.87）。评估PP变化显示与MACCE呈U形关联（Q1时为1.50；1.11-2.02，Q5时为1.47；0.98-2.20）。此外，Q5发生HF住院的风险更高（1.37；1.00-1.88）。
我们的研究结果表明PP变化与心血管结局之间呈U形关联。该数据表明PCI术后患者住院期间血压控制的重要性。
