The prognostic impact of pulse pressure in patients with ST-elevation myocardial infarction treated with successful primary percutaneous coronary intervention

Pulse pressure (PP) is readily available vital sing that can be an important prognostic marker for in-hospital mortality in patients with acute coronary syndrome. In patients with ST-elevation myocardial infarction (STEMI), successful opening of infarct related artery significantly reduces mortality and the occurrence of complications. The aim of our study was to analyze the impact of PP at admission on 30-day mortality in patients STEMI treated with successful primary percutaneous coronary intervention (pPCI).

we analyzed 3115 consecutive STEMI patients. Successful pPCI was defined as post-procedural flow TIMI=3. Patients with cardiogenic shock at admission were excluded. PP was calculated as the difference between systolic and diastolic blood pressure at hospital admission (and before pPCI). Patients were divided in three group according to the value of PP: normal PP 40-60mmHg; low PP <40mmHg and high PP >60mmHg.

Median age of all analyzed patients was 60 (52, 69) years and 2238(71.8%) patients were male. There were 2068 (66.4%) patients with normal PP 514(16.5%) patients with low PP and 533(17.1%) patients with high PP. Compared with patients with normal and high PP, those with low PP were older and presented more often with heart failure, atrial fibrillation and complete atrioventricular block; they were more likely to have diabetes mellitus, hypertension, reduced baseline kidney function (estimated glomerular filtration rate <60ml/min/m2), multivessel coronary artery disease (at initial angiogram) and lower predischarge left ventricular ejection fraction (EF). 30-days mortality was significantly higher in patients with low PP as compared with patients with normal and high PP- 9.6% vs 3.5% vs 3.6%, respectively, p<0.001), as shown in Figure 1. In the multivariable regression analysis low PP was a strong independent predictor for 30-day mortality: HR 1.99 (85%CI 1.09-3.65, p=0.024). Other predictors were older age, heart failure at admission, lower EF, previous myocardial infarction and reduced baseline kidney function.