Inverse relation between diastolic blood pressure and long-term outcomes in patients undergoing pharmacoinvasive therapy for myocardial infarction: the J-shaped relation in the contemporary era of revascularisation.

Abstract

OBJECTIVE:

In the thrombolytic era, it was reported that in the presence of significant coronary stenosis, lowering diastolic blood pressure (DBP) below a critical threshold would result in a paradoxical increase in the occurrence of myocardial infarction (MI). We sought to re-evaluate this J-shaped relation in the era of pharmacoinvasive therapy.

METHODS:

A total of 182 patients who underwent early (<1 week, mean 2.3 days) coronary angioplasty after thrombolysis were analysed.

RESULTS:

Thrombolytic agents (streptokinase in 60%, tissue plasminogen activator in 40%) were administered in an average door-to-needle time of 66 min (<=30 min in 43 [24%] patients). A thrombolysis in myocardial infarction (TIMI) 3 flow was achieved in 56% of patients after thrombolysis, and it was enhanced to 92% after angioplasty. During an average follow-up period of 26 +/-13 months, the adverse event (death, re-MI, target vessel revascularisation or stroke) rate was 21%. Older age, low systolic blood pressure and DBP, fast heart rate, high creatine kinase, hypercholesterolaemia, thrombus-laden lesion, baseline TIMI 0-2 flow were associated with higher occurrence of adverse events. After adjusting for the differing clinical and procedural factors, low DBP (odds ratio 1.10, 95% confidence interval 1.01-1.20, P = 0.041), fast heart rate (odds ratio 1.08, 95% confidence interval 1.02-1.14, P = 0.008) and anterior MI (odds ratio 18.98, 95% confidence interval 2.13-169.19, P = 0.008) were all independent predictors of long-term adverse rate occurrence.

CONCLUSIONS:

A low DBP is an independent predictor of long-term adverse event rates in patients undergoing routine early coronary angioplasty after thrombolysis. This suggests that excessive lowering of DBP may not be desirable before complete revascularisation.

• Authors: Chi Hang Lee, David Foo, Hwee Bee Wong, Eric C T Hong, Swee Chong Seow, Kheng Siang Ng, Yean Teng Lim, Huay Cheem Tan
• Journal: Journal of cardiovascular medicine (Hagerstown, Md.) (J Cardiovasc Med (Hagerstown)) Vol. 7 Issue 11 Pg. 806-11 (Nov 2006) ISSN: 1558-2027 [Print] United States
• PMID: 17060806 (Publication Type: Journal Article)

Chemical References

• Fibrinolytic Agents
• Streptokinase
• Tissue Plasminogen Activator

Topics

• Angioplasty, Balloon, Coronary (adverse effects)
• Blood Pressure (drug effects)
• Coronary Angiography
• Coronary Circulation (drug effects)
• Diastole
• Female
• Fibrinolytic Agents (pharmacology, therapeutic use)
• Follow-Up Studies
• Heart Rate (drug effects)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, mortality, physiopathology, surgery)
• Myocardial Revascularization (adverse effects)
• Odds Ratio
• Predictive Value of Tests
• ROC Curve
• Recurrence
• Research Design
• Risk Factors
• Sensitivity and Specificity
• Streptokinase (therapeutic use)
• Stroke (etiology)
• Thrombolytic Therapy
• Time Factors
• Tissue Plasminogen Activator (therapeutic use)
• Treatment Outcome