Effect Of Systolic Blood Pressure On Short-term Prognosis Of Patients With Acute Myocardial Infarction At Discharge

Objectives To investigate the relationship between systolic blood pressure(SBP)and major adverse cardiovascular events(MACE)in patients with acute myocardial infarction.Methods A total of 251 patients with acute myocardial infarction who were hospitalized in the Department of Cardiology,Hebei General Hospital from January 2019 to December2019 were selected,including 195 males and 56 females,with an average age of 60.96±12.23years.General clinical data were collected,including age,sex,body mass index(BMI),smoking,drinking,percutaneous coronary intervention(PCI),hypertension,diabetes,cerebral infarction,dyslipidemia,peripheral atherosclerosis and myocardial infarction type.Cardiac troponin T(c Tn T),blood urea nitrogen(BUN),uric acid(UA),fasting blood glucose(FBG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol LDL-C),very low density lipoprotein cholesterol(VLDL-C),triglyceride(TG),serum potassium,serum sodium,hemoglobin(Hb),absolute value of neutrophils,absolute value of lymphocytes,neutrophil to lymphocyte ratio(NLR),lipoprotein a(LPa),heart rate(HR),left ventricular ejection fraction(LVEF),killip grade at admission,as well as systolic blood pressure and medication at discharge.Including aspirin/indole bufen,clopidogrel/tegrel,statins,ezetimib,beta blockers,diuretics,angiotensin converting enzyme inhibitors(ACEI)/angiotensinⅡreceptor blocker(ARB)and calcium channel blockers(CCB).The patients were followed up by telephone We Chat or outpatient service after discharge.The end events were MACE including angina pectoris,recurrent non-fatal myocardial infarction,heart failure and cardiovascular death.The follow-up was terminated in December 2020.According to the level of systolic blood pressure at discharge,patients meeting the inclusion criteria were divided into four groups by quartile method:systolic blood pressure group 1(99.89±5.35,107mm Hg),systolic blood pressure group 2[113(110,116)107mm Hg-118mm Hg]systolic blood pressure group 3[121.5(120,125)118mm Hg-127mm Hg],systolic blood pressure group 4[135(131.25,149.75)>127mm Hg].Binary Logistic regression risk model was used to study the relationship between systolic blood pressure at discharge and MACE in patients with acute myocardial infarction.Kaplan-Meyer survival analysis curve and Log-Rankχ~2 test were used to compare the difference in the incidence of MACE free events among the four groups.Results 1 Comparison of general clinical data:age,sex,BMI,history of drinking,history of diabetes,history of dyslipidemia,history of cerebral infarction,history of peripheral atherosclerosis,PCI,creatinine,BUN,UA,FBG,TC,HDL-C,LDL-C,VLDL-C,TG,serum potassium,hemoglobin,neutrophils,lymphocytes,NLR,lipoprotein a,LVEF,heart rate.There was no significant difference in aspirin/indolebufen,statins,ezetimibe,diuretics andβ-blockers(P>0.05).There were significant differences in smoking history,hypertension history,myocardial infarction type,troponin,serum sodium,clopidogrel/tegrel,ACEI/ARB and CCB(P<0.05).2 Systolic blood pressure was positively correlated with hypertension history(r=0.335),serum sodium(r=0.170),ACEI/ARB(r=0.187)and CCB(r=0.300),and negatively correlated with smoking history(r=-0.187),myocardial infarction type(r=-0.131).3 Univariate Logistic regression analysis results of patients with acute myocardial infarction:univariate analysis showed that there were significant differences in sex,history of smoking,diabetes history and PCI,killip3-4 grade,myocardial infarction type,clopidogrel/tegrel,statins,age,creatinine,BUN,HDL-C,serum potassium,hemoglobin,heart rate,LVEF and systolic blood pressure at discharge.The results of multivariate Logistic regression analysis showed that myocardial infarction type,heart rate and systolic blood pressure at discharge at discharge were independent risk factors for the prognosis of acute myocardial infarction(AMI).4 Kaplan-Meier survival analysis curve and Log-rankχ~2 test were used to compare the incidence of MACE free events in the four groups.The results showed that the incidence of MACE free events in the systolic blood pressure group 3 group was significantly higher than that in the systolic blood pressure group 4 group,and the difference was statistically significant(P<0.0083).Conclusions The level of systolic blood pressure at discharge was a risk factor for the occurrence of MACE in patients with acute myocardial infarction within one year after discharge.Patients with AMI whose systolic blood pressure was controlled between118mm Hg-127mm Hg at discharge had a lower risk of MACE.Different systolic blood pressure levels at discharge were helpful to evaluate the clinical prognosis of patients with acute myocardial infarction.Figure 1;Table 6;Reference 136...