Hypertension is a well-known risk factor for
atherosclerosis. However, data on the 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 on patients undergoing primary angioplasty. The aim of the present study was to evaluate the impact of
hypertension on distal embolization, myocardial perfusion, and mortality in patients with
STEMI undergoing primary
percutaneous coronary intervention. Our population is represented by 1,662 patients undergoing primary angioplasty for
STEMI included in the Early
Glycoprotein IIb-IIIa inhibitors in Primary angioplasty database. Myocardial perfusion was evaluated by myocardial blush grade and ST segment resolution. Follow-up data were collected within 1 year after primary angioplasty.
Hypertension was observed in 700 patients (42.1%).
Hypertension was associated with more advanced age (p <0.001), female gender (p <0.001), diabetes (p <0.001),
hypercholesterolemia (p <0.001), previous revascularization (p <0.001), anterior
myocardial infarction (p = 0.006), longer
ischemia time (p = 0.03), more extensive
coronary artery disease (p = 0.002), more often treated with
abciximab (p <0.001), and less often smokers (p <0.001).
Hypertension was associated with impaired postprocedural myocardial blush grade 2 to 3 (68.2% vs 74.2%, p = 0.019) and complete ST segment resolution (51.7% vs 61.1%, p = 0.001). By a mean follow-up of 206 ± 158 days, 70 patients (4.3%) had died.
Hypertension was associated with a greater mortality (6.2% vs 2.9%, hazard ratio 2.31, 95% confidence interval 1.42 to 3.73, p <0.001), confirmed after correction for baseline confounding factors (hazard ratio 1.82, 95% confidence interval 1.03 to 3.22, p <0.001). In conclusion, this study showed that among patients with
STEMI undergoing primary angioplasty,
hypertension is associated with impaired reperfusion and independently predicts 1-year mortality.