Abstract:
Objective To investigate the relationship between short-term blood pressure variability(BPV) after primary percutaneous coronary intervention(PPCI) and adverse cardiovascular outcomes one year after operation in patients with acute ST segment elevation myocardial infarction(STEMI). Methods The clinical and prognostic data of 331 patients with STEMI who underwent PPCI and drug-eluting stent implantation were collected retrospectively in Cardiology Department of Subei People’s Hospital from January 1, 2016 to January 31, 2019. The correlation between blood pressure variability(BPV) and adverse cardiovascular outcome one year after operation was analyzed. Blood pressure standard deviation(SD) was used to evaluate individual systolic blood pressure variability(SBPV) and diastolic blood pressure variability(DBPV). According to the median of SD of systolic blood pressure(SBP) and diastolic blood pressure(DBP), the high SBPV group was defined as SD ≥11.42 mm Hg, while the high DBPV group was defined as SD ≥8.49 mm Hg. Multivariate bivariate logistic regression model was used to explore the correlation between SBPV, DBPV and major adverse cardiovascular events(MACE) 1 year after operation. Results Compared with the low SBPV group, the incidence of heart failure in the high SBPV group(21.1% vs 10.3%, χ~2=7.264) was significantly higher, while the incidence of heart failure(23.5% vs 7.9%, χ~2=15.237) and the cumulative incidence of MACE(29.5% vs 13.9%, χ~2=11.799) in the high DBPV group were higher than those in the low DBPV group(all P<0.05). After adjusting for age, sex, body mass index(BMI), antihypertensive drugs, left ventricular ejection fraction(LVEF), Gensini score and other influencing factors, multivariate binary logistic regression analysis showed that high SBPV was a risk factor for heart failure(OR=3.462, 95%CI 1.476-8.117, P=0.004), and high DBPV was a risk factor for heart failure and cumulative MACE(OR=4.535, 95%CI 1.725-11.926, P=0.002; OR=3.412, 95%CI 1.627-7.152, P=0.001, respectively). After adjusting for age, sex, BMI, antihypertensive drugs, LVEF, Gensini score and other influencing factors, multivariate binary logistic regression analysis showed that high SBPV was still a risk factor for heart failure(OR=4.328, 95%CI 1.619-11.572, P=0.004), as well as high DBPV for heart failure and cumulative MACE(OR=4.600, 95%CI 1.518-13.934, P=0.007; OR=4.942, 95%CI 1.851-13.198, P=0.001, respectively) in the subgroup hypertensives using oral antihypertensive drugs. Conclusion High BPV within 0.5 h to 3-4 days after PPCI and drug-eluting stent implantation in STEMI patients may be a risk factor for cardiovascular prognosis within 1 year after operation.