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Int J Cardiol. 2014 Jul 15;175(1):50-4. doi: 10.1016/j.ijcard.2014.04.180. Epub 2014 Apr 26.

Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES: insights from the DESERT cooperation.

Author information

1
Division of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it.
2
Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
3
Assistance Publique-Hopitaux de Paris Cochin Hospital, Paris 5 Medical School Rene Descartes University and INSERM Unite 780 Avenir, Paris, France.
4
The Heart Center, Rigshospitalet, Copenhagen, Denmark.
5
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
6
Cardiac Department, Skejby Hospital, Skejby, Denmark.
7
Department of Cardiology, University Hospital Basel, Switzerland.
8
Division of Cardiology, San Camillo Hospital, Rome, Italy.
9
Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy.
10
Hemodynamics and Interventional Cardiology Unit, University Hospital Virgen del Rocio, Seville, Spain.
11
Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy.
12
Division of Cardiology, "S.G. Moscati", Avellino, Italy.
13
Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands.
14
Columbia University Medical Center, New York City, NY, USA; Cardiovascular Research Foundation, New York City, NY, USA.

Abstract

BACKGROUND:

Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic 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 in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES.

METHODS:

Our population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI.

RESULTS:

Hypertension was observed in 2764 patients (43.9%), and associated with ageing (p<0.0001), female gender (p<0.001), diabetes (p<0.0001), hypercholesterolemia (p<0.0001), previous MI (p=0.002), previous revascularization (p=0.002), longer time-to-treatment (p<0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p<0.001) and anterior MI (42% vs 45.9%, p=0.002). Hypertension was associated with impaired postprocedural TIMI 0-2 flow (Adjusted OR [95% CI]=1.22 [1.01-1.47], p=0.034). At a follow-up of 1,201 ± 440 days, hypertension was associated with higher mortality (adjusted HR [95% CI]=1.24 [1.01-1.54], p=0.048), reinfarction (adjusted HR [95% CI]=1.31 [1.03-1.66], p=0.027), stent thrombosis (adjusted HR [95% CI]=1.29 [0.98-1.71], p=0.068) and TVR (adjusted HR [95% CI]=1.22 [1.04-1.44], p=0.013).

CONCLUSIONS:

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 ST.

KEYWORDS:

BMS; DES; Hypertension; Primary angioplasty; ST elevation myocardial infarction

PMID:
24852835
DOI:
10.1016/j.ijcard.2014.04.180
[Indexed for MEDLINE]
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