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<p>Elevated systolic blood pressure (SBP) increases myocardial oxygen demand, whereas low diastolic blood pressure (DBP) can impair coronary perfusion. The prognostic impact of this high-SBP/low-DBP (HSLD) profile in patients with ST-elevation myocardial infarction (STEMI) remains unknown. We analyzed 696 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI) from a prospective 11-center registry in Japan. Patients were categorized based on pre-procedural SBP (≥ 120 mmHg) and DBP (&lt; 70 mmHg) into four groups: high-SBP/low-DBP (HSLD) high-SBP/high-DBP (HSHD), low-SBP/high-DBP (LSHD), and low-SBP/low-DBP (LSLD). The primary endpoint was a 1-year composite of cardiovascular death, non-fatal myocardial infarction, or stroke. Median follow-up was 369 days. The 1-year cumulative incidence of the primary endpoint was 7 (9.5%) in the HSLD group, 19 (4.2%) in the HSHD group, 2 (2.8%) in the LSHD group, and 5 (6.0%) in the LSLD group (log-rank <i>p</i> = 0.007). In multivariable Cox regression, the HSLD was independently associated with the primary endpoint compared to the HSHD group (hazard ratio 3.20, 95% CI 1.04–9.87; <i>p</i> = 0.043). The prognostic value of HSLD was consistent across major subgroups. A pre-procedural blood pressure pattern of SBP ≥ 120 mmHg combined with DBP &lt; 70 mmHg independently predicts a higher risk of adverse cardiovascular events at 1 year in patients with STEMI. This simple measurement at admission identifies a previously unrecognized high-risk phenotype and presents a valuable opportunity for early risk stratification.</p>

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Prognostic impact of pre-procedural blood pressure profiles on clinical outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • Viroj Muangsillapasart,
  • Eiji Shibahashi,
  • Takanori Kawamoto,
  • Hisao Otsuki,
  • Hiroyuki Arashi,
  • Kazuho Kamishima,
  • Kentaro Jujo,
  • Toshiaki Oka,
  • Fumiaki Mori,
  • Hiroyuki Tanaka,
  • Tomohiro Sakamoto,
  • Yasuhiro Ishii,
  • Yutaka Terajima,
  • Masahiro Yagi,
  • Atsushi Takagi,
  • Shoji Haruta,
  • Junichi Yamaguchi

摘要

Elevated systolic blood pressure (SBP) increases myocardial oxygen demand, whereas low diastolic blood pressure (DBP) can impair coronary perfusion. The prognostic impact of this high-SBP/low-DBP (HSLD) profile in patients with ST-elevation myocardial infarction (STEMI) remains unknown. We analyzed 696 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI) from a prospective 11-center registry in Japan. Patients were categorized based on pre-procedural SBP (≥ 120 mmHg) and DBP (< 70 mmHg) into four groups: high-SBP/low-DBP (HSLD) high-SBP/high-DBP (HSHD), low-SBP/high-DBP (LSHD), and low-SBP/low-DBP (LSLD). The primary endpoint was a 1-year composite of cardiovascular death, non-fatal myocardial infarction, or stroke. Median follow-up was 369 days. The 1-year cumulative incidence of the primary endpoint was 7 (9.5%) in the HSLD group, 19 (4.2%) in the HSHD group, 2 (2.8%) in the LSHD group, and 5 (6.0%) in the LSLD group (log-rank p = 0.007). In multivariable Cox regression, the HSLD was independently associated with the primary endpoint compared to the HSHD group (hazard ratio 3.20, 95% CI 1.04–9.87; p = 0.043). The prognostic value of HSLD was consistent across major subgroups. A pre-procedural blood pressure pattern of SBP ≥ 120 mmHg combined with DBP < 70 mmHg independently predicts a higher risk of adverse cardiovascular events at 1 year in patients with STEMI. This simple measurement at admission identifies a previously unrecognized high-risk phenotype and presents a valuable opportunity for early risk stratification.