Lower DBP ups risk of adverse cardiovascular events in STEMI patients undergoing PCI

Lower diastolic blood pressure (DBP) appears to independently contribute to a higher risk of in-hospital major adverse cardiovascular events (MACE) and follow-up all-cause mortality, suggests a recent study.

A total of 2,198 consecutive patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) from January 2010 to June 2016 were included in this analysis. Participants were grouped according to the quintiles of DBP at admission.

Of the patients, 157 (7.1 percent) developed in-hospital MACE, the primary outcome, which included all-cause death, stroke, target vessel revascularization, and recurrent myocardial infarction. Those with DBP <60 mm Hg had a higher rate of in-hospital MACE (14.8 percent, 7.8 percent, 5.6 percent, and 3.8 percent; p<0.001) and all-cause death (12.5 percent, 6.4 percent, 4.3 percent, 3.9 percent, and 1.9 percent; p<0.001) than those with DBP 60‒69, 70‒79, 80‒89 and ≥90 mm Hg.

On multivariate logistic regression analysis, DBP >90 mm Hg significantly predicted a lower risk of in-hospital MACE (odds ratio, 0.16, 95 percent confidence interval, 0.04‒0.61; p=0.007). No U-type relationship was seen in cubic spline models for the association between DBP and MACE after adjusting for potential risk factors. Additionally, lower DBP correlated with an elevated risk of all-cause mortality during follow-up (p<0.0001).

“In patients with stable coronary artery disease, low DBP is associated with an increased risk of myocardial infarction and cardiovascular death,” the authors said.