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Healio
June 27, 2014
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Hypertension associated with poorer outcomes in STEMI patients treated with PCI

Hypertension was associated with impaired epicardial reperfusion and increased mortality in a cohort of patients who underwent primary PCI for STEMI, according to findings published in the International Journal of Cardiology.

Researchers suggested that findings on the prognostic effect of hypertension in STEMI demonstrate inconsistency and that such data are primarily from studies conducted in the thrombolytic era as opposed to the primary angioplasty era.

In the current study, they examined whether hypertension has a clinical impact on a cohort of 6,298 patients with STEMI who underwent primary PCI with bare-metal stents or drug-eluting stents.

Patients were culled from the DESERT database, which included 11 randomized trials comparing the two types of stents.

There were 2,764 patients with hypertension, or 43.9% of the population. Factors associated with hypertension included:

  • Aging (P<.0001);
  • Female gender (P<.001);
  • Diabetes (P<.0001);
  • Hypercholesterolemia (P<.0001);
  • Previous MI (P=.002);
  • Previous revascularization (P=.002);
  • Longer time-to-treatment (P<.001);
  • Pre-procedural TIMI 3 flow (P=.012).

Associations also were reported between hypertension and a lower prevalence of smoking (41% vs. 53.9%; P<.001) and less incidence of anterior MI (42% vs. 45.9%; P=.002).

Impaired post-procedural TIMI 0 to 2 flow also yielded a correlation with hypertension (adjusted OR=1.22; 95% CI, 1.01-1.47).

At 1,201 ± 440 days follow-up, patients in the hypertension group experienced higher mortality (HR=1.24; 95% CI, 1.01-1.54) and more frequent reinfarction (HR=1.31; 95% CI, 1.03-1.66), stent thrombosis (HR=1.29; 95% CI, 0.98-1.71) and target vessel revascularization (HR=1.22; 95% CI, 1.04-1.44).

“This study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher [stent thrombosis],” the researchers concluded.

Disclosure: The researchers report no relevant financial disclosures.

Sources/Disclosures

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Source: DeLuca G. Int J Cardiol. 2014;175:50-54.