急性 ST 段抬高型心肌梗死患者入院血压与自发性再灌注及长期预后的关系：一项观察性多中心研究。
Association between admission blood pressure and spontaneous reperfusion and long-term prognosis in STEMI patients: an observational and multicenter study.
机构信息
Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University,Hubei Key Laboratory of Cardiology, Wuhan, China.
Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
出版信息
BMC Cardiovasc Disord. 2024 Sep 18;24(1):500. doi: 10.1186/s12872-024-04168-4.
BACKGROUND
This study aims to assess the associations of admission systolic blood pressure (SBP) level with spontaneous reperfusion (SR) and long-term prognosis in ST-elevation myocardial infarction (STEMI) patients.
METHODS
Data from 3809 STEMI patients who underwent primary percutaneous coronary intervention within 24 h, as recorded in the Chinese STEMI PPCI Registry (NCT04996901), were analyzed. The primary endpoint was SR, defined as thrombolysis in myocardial infarction grade 2-3 flow of IRA according to emergency angiography. The second endpoint was 2-year all-cause mortality. The association between admission BP and outcomes was evaluated using Logistic regression or Cox proportional hazards models with restricted cubic splines, adjusting for clinical characteristics.
RESULTS
Admission SBP rather than diastolic BP was associated with SR after adjustment. Notably, this relationship exhibits a nonlinear pattern. Below 120mmHg, There existed a significant positive correlation between admission SBP and the incidence of SR (adjusted OR per 10-mmHg decrease for SBP ≤ 120 mm Hg: 0.800; 95% CI: 0.706-0.907; p<0.001); whereas above 120mmHg, no further improvement in SR was observed (adjusted OR per 10-mmHg increase for SBP >120 mm Hg: 1.019; 95% CI: 0.958-1.084, p = 0.552). In the analysis of the endpoint event of mortality, patients admitted with SBP ranging from 121 to 150 mmHg exhibited the lowest mortality compared with those SBP ≤ 120mmHg (adjusted HR: 0.653; 95% CI: 0.495-0.862; p = 0.003). In addition, subgroups analysis with Killip class I-II showed SBP ≤ 120mmHg was still associated with increased risk of mortality.
CONCLUSION
The present study revealed admission SBP above 120 mmHg was associated with higher SR,30-d and 2-y survival rate in STEMI patients. The admission SBP could be a marker to provide clinical assessment and treatment.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT04996901), 07/27/2021.
背景
本研究旨在评估入院时收缩压（SBP）水平与 ST 段抬高型心肌梗死（STEMI）患者自发再灌注（SR）和长期预后的关系。
方法
对 3809 例 STEMI 患者的临床数据进行分析，这些患者在 24 小时内行直接经皮冠状动脉介入治疗（NCT04996901），这些数据来自中国 STEMI 直接经皮冠状动脉介入治疗注册研究。主要终点是 SR，定义为根据紧急血管造影判断 IRA 的心肌梗死溶栓治疗（TIMI）血流达到 2-3 级。次要终点是 2 年全因死亡率。采用 Logistic 回归或 Cox 比例风险模型，用限制立方样条对入院时血压与结局的关系进行评估，调整临床特征。
结果
入院 SBP 与 SR 相关，而不是舒张压，调整后结果依然如此。值得注意的是，这种关系呈非线性模式。在 120mmHg 以下，入院 SBP 与 SR 的发生率呈显著正相关（调整后 SBP 每降低 10mmHg，SBP≤120mmHg 的 OR 值为 0.800；95%CI：0.706-0.907；p<0.001）；而在 120mmHg 以上，SR 无进一步改善（调整后 SBP>120mmHg 每增加 10mmHg，OR 值为 1.019；95%CI：0.958-1.084，p=0.552）。在死亡率终点事件分析中，与 SBP≤120mmHg 相比，SBP 为 121-150mmHg 的患者死亡率最低（调整 HR：0.653；95%CI：0.495-0.862；p=0.003）。此外，亚组分析显示，Killip 分级 I-II 级患者中，SBP≤120mmHg 仍与死亡率升高相关。
结论
本研究表明，入院时 SBP 高于 120mmHg 与 STEMI 患者更高的 SR、30 天和 2 年生存率相关。入院时的 SBP 可以作为一个标志物，提供临床评估和治疗。
试验注册
ClinicalTrials.gov（NCT04996901），2021 年 7 月 27 日。
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