Correlation Between In-hospital Blood Pressure Variability And Renal Function Decline After PCI In Patients With STEMI

Objective:To investigate the correlation between in-hospital blood pressure variability and the decline in renal function after percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:The clinical data of 305 patients with confirmed STEMI who underwent PCI were collected retrospectively in Cardiology Department of Jiangsu Subei People’s Hospital from January 2016 to June2019.The blood pressure of patients within 4 days after PCI was obtained,standard deviation(SD),coefficient of variation(CV),and average real variability(ARV)were used as the measures of BPV.The systolic blood pressure variability(SBPV)group was defined as SD≥11.7mm Hg and the diastolic blood pressure variability(DBPV)group was defined as SD≥8.7mm Hg.Serum creatinine data were obtained at baseline,6months,1 year and 2 years after PCI,and the glomerular filtration rate(e GFR)was calculated at each time point.The e GFR slope was used as the evaluation parameter of renal function decline,and rapid decline in renal function was defined as e GFR≥3m L/min/1.73m~2/year.Multiple linear regression was used to analyze the correlation between BPV and the decline in renal function after PCI in STEMI patients.Results:The mean value of e GFR slope was-2.1m L/min/1.73m~2/year,and rapid decline in renal function occurred in 57 patients(18.6%).There was a significant correlation between BPV and e GFR slope,SBPV(SD:r=-0.267,P<0.001;CV:r=-0.214,P<0.001;ARV:r=-0.116,P=0.043),DBPV(SD:r=-0.231,P<0.001;CV:r=-0.193,P=0.001;ARV:r=-0.150,P=0.009).After correcting for confounding factors such as age,sex,BMI,mean blood pressure,baseline e GFR,hypertension,diabetes,dyslipidemia,diuretics and angiotensin II receptor antagonist(ARB),BPV for each individual was significantly still associated with e GFR slope.The standard deviation of systolic blood pressure(SBPSD)cutoff value for predicting the occurrence of rapid decline in renal function by subject operator characteristic(ROC)curve was 14.0 mm Hg,the standard deviation of diastolic blood pressure(DBPSD)cutoff value was 8.8 mm Hg.Conclusion:This study found that BPV during hospitalization was significantly correlated with the decline in renal function in patients with STEMI after PCI,it could be used as a good predictor of the decline in renal function.