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ȣ - 530175 143 |
| Impact of High Normal Blood Pressure on Adverse Cardiac Events in Acute Myocardial Infarction |
| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 윤남식, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
Background: Prehypertension according to JNC7 is common and is associated with increased vascular mortality. The importance of management in "high normal blood pressure (BP)" according to ESH 2007 definition is underemphasized. Methods: We analyzed major adverse cardiac events (MACE: death, myocardial infarction, re-PCI, and CABG) in Korea Acute Myocardial Infarction Registry (KAMIR) in normal BP (group I) and high normal BP (group II) patients according to ESH 2007 definition. Patients without hypertension, angina, dyspnea, bradycardia, and tachycardia were enrolled to avoid effects of sympathetic tone. Results: Among 14,871 patients, 159 patients (61 ± 12.3 years, 122 males) were satisfied with enrollment. Six-month and one-year clinical follow-up rate were 88.9 % and 85.8 %. Group I had 78 patients (61 ± 12.5 years) and Group II 81 patients (61 ± 12.4 years). Diabetes, dyslipidemia, smoking history, familial history and BMI were not different between groups. STEMI was 43.6 % in group I and 44.6 % in group II (p = ns). Treatment strategy including door to PCI time was not different. The number of involved vessels (2.0 ± 0.94 vs. 1.6 ± 0.83, p = 0.017) was less in group II, Pre-PCI TIMI flow was higher in group II (2.3 ± 1.34 vs. 3.0 ± 1.23, p = 0.003). Left ventricular ejection fraction (53.9 ± 10.60 % vs. 54.8 ± 12.00 %, p = ns) and other laboratory findings were not different. Successful intervention rate was higher in group II (95.2 % vs. 100 %). In-hospital death occurred in 0 (0 %) vs. 1 (1.25 %) patient (p = 0.320). One-month composite MACE occurred in 0 (0 %) vs. 7 (10.29 %) patients (p=0.007). Six-month composite MACE occurred in 3 (4.41 %) vs. 10 (15.63 %) patients (p=0.034). One-year composite MACE occurred in 6 (8.96 %) vs. 11 (18.97 %) patients (p=0.113). Compared with normal BP, hazard ratio for patients with high normal BP was 1.143 (P=0.044, 95 % CI, 1.004 to 1.303) for six-month MACE. Conclusion: Even though high normal BP patients had better baseline clinical situation, follow-up MACE was poorer in KAMIR than patients with normal BP. It seemed to prove the importance of BP-control in high normal BP patients.
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