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Impact of controlled blood pressure and pulse rate at discharge on clinical outcomes in patients with ST-segment elevation myocardial infarction.
- Source :
-
Journal of cardiology [J Cardiol] 2024 Jun; Vol. 83 (6), pp. 394-400. Date of Electronic Publication: 2023 Oct 04. - Publication Year :
- 2024
-
Abstract
- Background: Although major guidelines recommend the routine introduction of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) and beta-blockers for patients with ST-segment elevation myocardial infarction (STEMI), evidence regarding the target blood pressure (BP) or pulse rate (PR) at hospital discharge is sparse. This retrospective study aimed to compare the clinical outcomes in patients with STEMI between those with good BP and PR control and those with poor BP or PR control.<br />Methods: We included 748 patients with STEMI who received both ACE inhibitors/ARBs and beta-blockers at hospital discharge, and divided them into a good control group (systolic BP ≤140 mmHg and PR ≤80 bpm, n = 564) and a poor control group (systolic BP >140 mmHg or PR >80 bpm, n = 184). The primary endpoint was major cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction, and re-admission for heart failure.<br />Results: During the median follow-up duration of 568 days, a total of 119 MACE were observed. The Kaplan-Meier curves showed that MACE were more frequently observed in the poor control group (p = 0.009). In the multivariate Cox hazard analysis, the good control group was inversely associated with MACE (HR 0.656, 95 % CI: 0.444-0.968, p = 0.034) after controlling for multiple confounding factors.<br />Conclusions: The good control of systolic BP and PR at discharge was inversely associated with long-term adverse events in STEMI patients treated with both ACE inhibitors/ARBs and beta blockers. This study suggests the importance of titration of ACE inhibitors/ARBs and beta-blockers for better clinical outcomes in patients with STEMI.<br />Competing Interests: Declaration of competing interest Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, Japan Lifeline, Kaneka, and NIPRO. Dr. Jinnouchi has received speaking honoraria from Abbott Vascular. Prof. Fujita has served as a consultant for Mehergen Group Holdings, Inc.<br /> (Copyright © 2023 Elsevier Ltd. All rights reserved.)
- Subjects :
- Humans
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Angiotensin Receptor Antagonists therapeutic use
Blood Pressure
Heart Rate
Patient Discharge
Retrospective Studies
Adrenergic beta-Antagonists therapeutic use
Treatment Outcome
ST Elevation Myocardial Infarction drug therapy
ST Elevation Myocardial Infarction etiology
Percutaneous Coronary Intervention adverse effects
Myocardial Infarction etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1876-4738
- Volume :
- 83
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 37802203
- Full Text :
- https://doi.org/10.1016/j.jjcc.2023.09.013