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Atherosclerosis. 2018 Oct;277:219-226. doi: 10.1016/j.atherosclerosis.2018.07.013. Epub 2018 Jul 20.

Prognostic value of pulse pressure after an acute coronary syndrome.

Author information

1
Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
2
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
3
University Hospital la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
4
Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
5
Institute of Social and Preventive Medicine, and Clinical Trials Unit, Department of Clinical Research, University of Bern, Bern, Switzerland.
6
Department of Cardiology, University Heart Center, University Hospital of Zurich, Zurich, Switzerland.
7
Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
8
Department of General Internal Medicine, University Hospital of Bern, Bern, Switzerland.
9
Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: Olivier.Muller@chuv.ch.

Abstract

BACKGROUND AND AIMS:

Pulse pressure (PP) is a surrogate of aortic stiffness (AS) easily obtainable. The link between AS and cardio-vascular disease is documented, however, data regarding acute coronary syndrome (ACS) patients are scarce and contradictory. We aimed to assess the prognostic value of PP measured at admission, with regard to major adverse outcomes (all-cause mortality, recurrence of MI, and stroke), during the first year following an acute coronary syndrome (ACS).

METHODS:

The SPUM-ACS project is a prospective cohort study of patients with ACS conducted in 4 Swiss University hospitals. Patients with no PP at admission or with severe clinical heart failure or cardiogenic shock were excluded. Cox regression analyses were performed to determine associations between PP and outcomes (all-cause mortality, recurrence of myocardial infarction (MI), and stroke). Three multivariate Cox regression models were adjusted for hemodynamic, cardiovascular, and non-cardiovascular confounders, added successively.

RESULTS:

Of 5635 eligible patients, 5070 met the inclusion criteria. Mean patient age was 63 years (range: 54-72), 79.6% were male, and mean blood pressure and PP were 93.9 ± 15.6 and 54 ± 17 mmHg, respectively. Multivariate analyses confirmed the prognostic significance of PP for each 10-mmHg increase for the composite endpoint, hazard ratio (HR) 1.126 [1.051-1.206], p = 0.001; all-cause mortality, HR1.129 [1.013-1.260], p = 0.029; and recurrence of MI, HR1.206 [1.102-1.320], p < 0.001; but not for stroke, HR1.014[0.853-1.205].

CONCLUSIONS:

PP measured at admission is a strong, independent prognostic marker predicting mortality and recurrence of MI after ACS. PP should be considered for the management of secondary prevention.

KEYWORDS:

Acute coronary syndrome; Aortic stiffness; Cardiovascular events; Prognosis; Pulse pressure

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