| Background: Acute myocardial infarction(AMI),as the most serious types of coronary heart disease,has the characteristics of high morbidity,rapid disease progression and high mortality,which seriously threatens human health.With the establishment of chest pain centers and the emergence of new treatments over the past decades,the in-hospital mortality rate of AMI patients has decreased from 30% to 5%.However,the long-term mortality of AMI is still high.Previous studies have shown that blood pressure control in the acute phase of AMI is very important to the prognosis of patients.However,the relationship between optimal blood pressure(BP)control during the first 7 days of hospitalization and risk of long term mortality in patients with AMI remains unclear.Objective: 1.To determine the blood pressure and long-term mortality of patients with AMI.2.To explore the association between blood pressure in the first-week of hospitalization and risk of long term mortality in patients with acute left ventricular myocardial infarction(MI).3.To explore the association between blood pressure in the first-week of hospitalization and risk of long term mortality in patients with acute right ventricular MI.Methods: 1.We performed a retrospective cohort study with 4655 AMI patients.The patients from the Third Xiangya Hospital of Central South University,Xiangtan Central Hospital,and the First Affiliated Hospital of University of South China between January 1,2013 and December 31,2017 were enrolled.A total of 492 cases were excluded according to the exclusion criteria,and finally 4163 cases were included in the study.The date of termination of follow-up was July 31,2021.The primary outcomes were all-cause death and cardiovascular death.2.In the patients with acute left ventricular MI,Cox proportional hazards regression model was used to evaluate the risk of all-cause death and cardiovascular death in systolic blood pressure(SBP)and diastolic blood pressure(DBP)subgroups,and the hazard ratio(HR)and 95% confidence interval(CI)were calculated.Kaplan-Meier survival curve was used to compare the difference of cumulative death rate among blood pressure subgroups.The relationship between mean blood pressure in the first week of hospitalization and the outcome was analyzed by cubic spline analysis.To minimize potential bias in the study,we performed sensitivity analysis of four Cox proportional hazards regression models to assess the robustness of the association between BP subgroups and prognosis.3.In the patients with acute right ventricular MI,Cox proportional hazards regression model was used to evaluate the risk of all-cause death and cardiovascular death in SBP and DBP subgroups.Kaplan-Meier survival curve was used to compare the difference of cumulative death rate among blood pressure subgroups.The relationship between mean blood pressure in the first week of hospitalization and the outcome was analyzed by cubic spline analysis.To minimize potential bias in the study,we performed sensitivity analysis of four Cox proportional hazards regression models to assess the robustness of the association between BP subgroups and prognosis.Results: 1.Determining the baseline data and long-term mortality of patients with AMI: This study cohort included 4298 patients.The median length of stay was 7(IQR 6–10)days,the median follow-up was 5(IQR 4–6)years.The mean blood pressure values were grouped in 10 mm Hg increments.SBP was divided into seven subgroups: SBP ≤ 90 mm Hg,90 < SBP ≤ 100 mmhg,100 <SBP ≤ 110 mmhg,110 < SBP ≤ 120 mmhg,120 < SBP ≤ 130 mmhg,130 < SBP ≤ 140 mm Hg and SBP > 140 mm Hg.The 5-year mortality of subgroup 110 < SBP ≤ 120 mmhg was the lowest,which was14.3%.DBP was divided into four subgroups: DBP < 60 mmhg,60 ≤DBP ≤ 70 mmhg,70 < DBP ≤ 80 mm Hg and DBP > 80 mm Hg.The5-year mortality of subgroup 70 < DBP ≤ 80 mm Hg was the lowest,which was 15.5%.The statistical methods were used to screen the risk factors of long-term death in patients with AMI,and comprehensively analyzed based on previous research literature,the variables age,gender,smoking,heart rate,low-density lipoprotein cholesterol(LDL-C),fast blood glucose(FBG),coronary multivessel lesion,left main coronary artery disease,angiotensin-converting enzyme inhibitor(ACEI),angiotensin receptor blocker(ARB),calcium-channel blocker(CCB)and β-receptor blockers(β-blocker),aspirin,clopidogrel and ticgrero,statins,atrial fibrillation,diabetes,hypertension,cerebral hemorrhage,coronary artery bypass graft surgery(CABG),emergency percutaneous transluminal coronary intervention(PCI)are confounders.2.To explore the relationship between blood pressure in the first week of hospitalization and death risk in patients with acute left ventricular myocardial infarction: We performed a retrospective study in 3108 patients with acute isolated left ventricular MI in Hunan Province,China.Using a Cox model after adjusting potential confounders,in SBP subgroup,all-cause mortality was higher in patients with SBP ≤90 mm Hg(HR 7.12,95% CI 3.13–16.19;P <0.001)and SBP >130 mm Hg(HR 1.51,95% CI 1.12–2.03;P =0.007)[reference: 110 < SBP ≤120 mm Hg],respectively.In DBP subgroup,primary outcome was higher in patients with higher DBP<60 mm Hg(HR 1.76,95% CI 1.14–2.71;P = 0.011)and DBP >80mm Hg(HR 1.61,95% CI 1.20–2.18;P = 0.002)[reference: 70 <DBP ≤80 mm Hg],respectively.The cubic splines analysis for the relationship between SBP and DBP subgroups and the outcomes showed a U-shaped shaped curve,with an increased event rate at low and high BP.The results of sensitivity analysis were consistent with the above.3.To explore the relationship between blood pressure in the first week of hospitalization and death risk in patients with acute right ventricular MI: We performed a retrospective study in 1055 patients with acute isolated right ventricular MI in Hunan Province,China.Using a Cox model after adjusting potential confounders,in SBP subgroup,all-cause mortality was higher in patients with SBP≤100 mm Hg(HR 2.06,95%CI 1.08–3.96;P = 0.029)and SBP >140mm Hg(HR 2.06,95%CI 1.06–4.01;P = 0.034)[reference: 110 <SBP ≤120 mm Hg],respectively.In DBP subgroup,primary outcome was higher in patients with higher DBP <60 mm Hg(HR2.61,95%CI 1.26-5.37;P = 0.009)and DBP >80 mm Hg(HR 1.93,95%CI 111-3.35;P = 0.02)[reference: 70 < DBP ≤80 mm Hg],respectively.The cubic splines analysis for the relationship between SBP and DBP subgroups and the all-cause mortality showed a U-shaped shaped curve.When the outcome was cardiovascular death,the results were not statistically significant.The results of sensitivity analysis were consistent with the above.Conclusion: 1.The 5-year mortality was lowest in subgroups110 < SBP ≤ 120 mm Hg and 70 < DBP ≤ 80 mm Hg.2.A U-shaped shaped curve association existed between BP control in the first week of hospitalization and outcomes in patients with acute left ventricular MI.Maintaining a SBP from 90 mm Hg to130 mm Hg and a DBP from 60 mm Hg to 80 mm Hg resulted in the lowest 5-year overall and cardiovascular mortality.3.A U-shaped shaped curve association existed between BP control in the first week of hospitalization and all-cause mortality in patients with acute right ventricular MI.The patients with a SBP ranged from 100 mm Hg to 140 mm Hg and a DBP from 60 mm Hg to80 mm Hg had the lowest 5-year overall mortality.When the outcome was cardiovascular death,the results were not statistically significant. |
PDF Full Text Request