TY - JOUR
T1 - Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES
T2 - Insights from the DESERT cooperation
AU - De Luca, Giuseppe
AU - Dirksen, Maurits T.
AU - Spaulding, Christian
AU - Kelbæk, Henning
AU - Schalij, Martin
AU - Thuesen, Leif
AU - Van Der Hoeven, Bas
AU - Vink, Marteen A.
AU - Kaiser, Christoph
AU - Musto, Carmine
AU - Chechi, Tania
AU - Spaziani, Gaia
AU - Diaz De La Llera, Luis Salvador
AU - Pasceri, Vincenzo
AU - Di Lorenzo, Emilio
AU - Violini, Roberto
AU - Suryapranata, Harry
AU - Stone, Gregg W.
PY - 2014/7/15
Y1 - 2014/7/15
N2 - Background Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES. Methods Our population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI. Results Hypertension was observed in 2764 patients (43.9%), and associated with ageing (p < 0.0001), female gender (p < 0.001), diabetes (p < 0.0001), hypercholesterolemia (p < 0.0001), previous MI (p = 0.002), previous revascularization (p = 0.002), longer time-to-treatment (p < 0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p < 0.001) and anterior MI (42% vs 45.9%, p = 0.002). Hypertension was associated with impaired postprocedural TIMI 0-2 flow (Adjusted OR [95% CI] = 1.22 [1.01-1.47], p = 0.034). At a follow-up of 1201 ± 440 days, hypertension was associated with higher mortality (adjusted HR [95% CI] = 1.24 [1.01-1.54], p = 0.048), reinfarction (adjusted HR [95% CI] = 1.31 [1.03-1.66], p = 0.027), stent thrombosis (adjusted HR [95% CI] = 1.29 [0.98-1.71], p = 0.068) and TVR (adjusted HR [95% CI] = 1.22 [1.04-1.44], p = 0.013). Conclusions This study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher ST.
AB - Background Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES. Methods Our population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI. Results Hypertension was observed in 2764 patients (43.9%), and associated with ageing (p < 0.0001), female gender (p < 0.001), diabetes (p < 0.0001), hypercholesterolemia (p < 0.0001), previous MI (p = 0.002), previous revascularization (p = 0.002), longer time-to-treatment (p < 0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p < 0.001) and anterior MI (42% vs 45.9%, p = 0.002). Hypertension was associated with impaired postprocedural TIMI 0-2 flow (Adjusted OR [95% CI] = 1.22 [1.01-1.47], p = 0.034). At a follow-up of 1201 ± 440 days, hypertension was associated with higher mortality (adjusted HR [95% CI] = 1.24 [1.01-1.54], p = 0.048), reinfarction (adjusted HR [95% CI] = 1.31 [1.03-1.66], p = 0.027), stent thrombosis (adjusted HR [95% CI] = 1.29 [0.98-1.71], p = 0.068) and TVR (adjusted HR [95% CI] = 1.22 [1.04-1.44], p = 0.013). Conclusions This study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher ST.
KW - BMS
KW - DES
KW - Hypertension
KW - Primary angioplasty
KW - ST elevation myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=84902547390&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2014.04.180
DO - 10.1016/j.ijcard.2014.04.180
M3 - Article
C2 - 24852835
AN - SCOPUS:84902547390
VL - 175
SP - 50
EP - 54
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 1
ER -