Journal of Clinical Hypertension, 2019. 21(6), 774-785, DOI: https://doi.org/10.1111/jch.13534

Association between pulse pressure at discharge and clinical outcomes in patients with acute myocardial infarction: From the KAMIR‐Korean‐NIH registry

Hyun Woong Park, Min Gyu Kang;Kyehwan Kim;Jin-Sin Koh;Jeong Rang Park;Seok-Jae Hwang;Hye Ree Kim;Young-Hoon Jeong;Jong Hwa Ahn;Jeong Yoon Jang;Choong Hwan Kwak;Yongwhi Park;Jin-Yong Hwang;Myung Ho Jeong;Hyo-Soo Kim;Chang-Hwan Yoon;Doo-Il Kim;on behalf of the KAMIR-Korean-NIH registry

Abstract

Pulse pressure (PP) is affected by arterial stiffness and is a predictor of cardiovascular events. However, value and utility of PP assessment in patients with acute myocardial infarction (AMI) remain less clear. We aimed to evaluate the association between PP and cardiovascular events in surviving patients with AMI at discharge. A total of11 944 surviving patients with AMI at discharge from a Korean nationwide registry were included. Blood pressure was checked just before discharge. Noncardiac death and major adverse cardiovascular events (MACEs) including cardiac death, AMI, and stroke after discharge were analyzed. The median follow‐up duration was 368 (IQR339, 388) days. The rate of MACEs and cardiac death was higher in groups with the lowest PP (PP < 20 mm Hg) and highest PP (PP ≥ 71 mm Hg) and lowest in the group with PP of 31‐40 mm Hg. With PP of 31‐40 mm Hg as reference, univariate analysis showed a U‐shaped association between the risk of MACEs (PP ≤ 20 mm Hg: hazard ratio [HR] 2.3; PP ≥ 71 mm Hg: HR 2.7) or cardiac death (PP ≤ 20 mm Hg: HR 2.6; PP ≥ 71 mm Hg: HR 3.1) and PP. In multivariate analysis, the curve changed from being U‐shaped to J‐shaped, and HR for PP ≥ 71 mm Hg (1.2 for MACEs and 1.4 cardiac death) decreased and HR for PP < 20 (2.1 for MACEs and 2.4 for cardiac death) did not significantly decrease after adjustment for cardiovascular risk factors. Our findings indicate that PP is a strong independent prognostic factor of MACEs and cardiac death in surviving patients with AMI. Low PP is a more significant independent predictor of MACEs and cardiac death than high PP in surviving patients after AMI.

• DOI: https://doi.org/10.1111/jch.13534
• ISBN or ISSN: 1751-7176

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.