Song ZhiFeng, Danzeng Chilie, Jiang Yu, Yang JinGang, Yang WeiXian, Qian HaiYan, Yang YueJin
Center for Coronary Heart Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100037 Beijing, China.
Rev Cardiovasc Med. 2025 Aug 30;26(8):33512. doi: 10.31083/RCM33512. eCollection 2025 Aug.
Globally, acute myocardial infarction (AMI) is among the primary causes of mortality. The ideal approach for blood pressure (BP) management for patients experiencing ST-segment elevation myocardial infarction (STEMI) who receive percutaneous coronary intervention (PCI) remains a topic of ongoing debate. Current guidelines on BP management lack specific recommendations for STEMI patients undergoing PCI, resulting in substantial individual variability and uncertainties in clinical treatment strategies. This research seeks to determine the ideal BP levels linked to the lowest risk of in-hospital mortality and long-term adverse endpoints in STEMI patients receiving PCI.
This retrospective study analyzed data from the China Acute Myocardial Infarction (CAMI) Registry, enrolling 10,482 STEMI patients undergoing PCI at 108 Chinese hospitals from January 2013 to September 2014. The primary outcome was in-hospital mortality. Secondary outcomes included 2-year all-cause mortality, severe bleeding, and major adverse cardiac and cerebrovascular events (MACCEs), defined as a combination of all-cause mortality, myocardial infarction (MI), or stroke. The analysis of the relationship between admission systolic blood pressure (SBP)/diastolic blood pressure (DBP) and the primary and secondary outcomes as continuous and categorical variables was conducted using restricted cubic spline (RCS) analysis and Cox regression models.
RCS analysis revealed that a J-shaped association existed between admission SBP/DBP and the risk of the primary outcome, with significant nonlinearity (both < 0.001). Both lower and higher SBP/DBP levels were linked to an elevated risk of in-hospital mortality. The ideal SBP/DBP levels to minimize the in-hospital mortality risk were 157/94 mmHg. Compared to the reference SBP/DBP group (120-129/70-79 mmHg), lower admission SBP (<109 mmHg) or DBP (60-69 mmHg) significantly elevated the risk of the primary outcome. The adjusted hazard ratio (HR) for SBP levels of 100-109 mmHg and <100 mmHg was 1.08 (95% confidence interval (CI): 1.00-1.17; = 0.0395 and = 0.043, respectively), and for DBP of 60-69 mmHg, the adjusted HR was 1.07 (95% CI: 1.01-1.14, = 0.0305). Similarly, the J-shaped curve was also noted between SBP/DBP and secondary outcomes, such as all-cause mortality, severe bleeding and MACCEs. However, no significant non-linear relationship was observed between SBP/DBP and recurrent MI at 2-year follow-up.
Among STEMI patients undergoing PCI, a J-curve relationship in in-hospital mortality was observed with a nadir at 157/94 mmHg. Similar J-shaped trends were also observed for secondary outcomes including all-cause mortality, severe bleeding and MACCEs. However, no significant nonlinear correlation was found between admission BP and recurrent MI within 2 years.
NCT01874691, https://www.clinicaltrials.gov/study/NCT01874691?term=NCT01874691&rank=1.
在全球范围内，急性心肌梗死（AMI）是主要的死亡原因之一。对于接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者，理想的血压（BP）管理方法仍是一个持续争论的话题。目前关于血压管理的指南缺乏针对接受PCI的STEMI患者的具体建议，导致临床治疗策略存在很大的个体差异和不确定性。本研究旨在确定与接受PCI的STEMI患者院内死亡风险和长期不良终点风险最低相关的理想血压水平。
这项回顾性研究分析了中国急性心肌梗死（CAMI）注册研究的数据，纳入了2013年1月至2014年9月在中国108家医院接受PCI的10482例STEMI患者。主要结局是院内死亡。次要结局包括2年全因死亡率、严重出血以及主要不良心脑血管事件（MACCE），MACCE定义为全因死亡率、心肌梗死（MI）或中风的组合。使用受限立方样条（RCS）分析和Cox回归模型对入院收缩压（SBP）/舒张压（DBP）与主要和次要结局之间的关系进行连续和分类变量分析。
RCS分析显示，入院SBP/DBP与主要结局风险之间存在J形关联，具有显著的非线性（均P<0.001）。较低和较高的SBP/DBP水平均与院内死亡风险升高相关。使院内死亡风险降至最低的理想SBP/DBP水平为157/94 mmHg。与参考SBP/DBP组（120 - 129/70 - 79 mmHg）相比，较低的入院SBP（<109 mmHg）或DBP（60 - 69 mmHg）显著增加了主要结局的风险。SBP水平为100 - 109 mmHg和<100 mmHg时的调整后风险比（HR）分别为1.08（95%置信区间（CI）：1.00 - 1.17；P = 0.0395和P = 0.043），DBP为60 - 69 mmHg时，调整后HR为1.07（95%CI：1.01 - 1.14，P = 0.0305）。同样，SBP/DBP与次要结局（如全因死亡率、严重出血和MACCE）之间也呈现J形曲线。然而，在2年随访中，未观察到SBP/DBP与复发性MI之间存在显著的非线性关系。
在接受PCI的STEMI患者中，观察到院内死亡率呈J形曲线关系，最低点为157/94 mmHg。在包括全因死亡率、严重出血和MACCE等次要结局中也观察到类似的J形趋势。然而，未发现入院血压与2年内复发性MI之间存在显著的非线性相关性。
NCT01874691，https://www.clinicaltrials.gov/study/NCT01874691?term=NCT01874691&rank=1
