Korean Circ J.  2017 Jul;47(4):446-454. 10.4070/kcj.2017.0008.

Blood Pressure Targets and Clinical Outcomes in Patients with Acute Myocardial Infarction

• Park H
• Hong YJ
• Cho JY
• Sim DS
• Yoon HJ
• Kim KH
• Kim JH
• Ahn Y
• Jeong MH
• Cho JG
• Park JC
• other Korean Acute Myocardial Infarction Registry Investigators

• KMID: 2392881
• DOI: http://doi.org/10.4070/kcj.2017.0008

Abstract

BACKGROUND AND OBJECTIVES
The optimal blood pressure (BP) target in patients with a history of acute myocardial infarction (MI) remains as a subject of debate. The "˜J curve phenomenon' has been suggested as a target for BP control, however, it is unclear whether this phenomenon can be applied to MI patients. We analyzed patients with acute MI and investigated whether the "˜J curve phenomenon' exists in this population.
SUBJECTS AND METHODS
Data were obtained from a nationwide prospective Korea Acute Myocardial Infarction Registry, which included 10337 patients with acute MI who underwent percutaneous coronary intervention (PCI) between 2011 and 2014. The patients were divided into quintiles according to systolic blood pressure (SBP) and diastolic blood pressure (DBP), which were measured during a two-year clinical follow up. Two-year cumulative incidence of major adverse cardiac events (MACE) was analyzed among the groups.
RESULTS
MACE was defined as a composite of cardiac death, need for recurrent revascularization (repeated PCI or coronary arterial bypass graft due to recurrent anginal symptoms or reoccurrence of MI), ischemic cerebrovascular accident, and need for hospitalization due to heart failure. During the two-year follow up, the total cumulative incidence of MACE was 9.7% (n=1005). BP-MACE analysis showed a U-shaped curve for both SBP and DBP, with the lowest MACE rate in quintiles with an average SBP of 112.2 mmHg and DBP of 73.3 mmHg. On Cox regression analysis, the U-shaped relation was statistically significant.
CONCLUSION
In patients with acute MI, a "˜U curve phenomenon' was observed when assessing patient BP control versus MACE rate.

Keyword

Blood pressure; Myocardial infarction; Prognosis

MeSH Terms

Blood Pressure*
Death
Follow-Up Studies
Heart Failure
Hospitalization
Humans
Incidence
Korea
Myocardial Infarction*
Percutaneous Coronary Intervention
Prognosis
Prospective Studies
Stroke
Transplants

Figure

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  Fig. 1 Blood pressure distribution in each quintile.

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  Fig. 2 Two-year cumulative incidence of MACE. Values in each group are presented as MACE rate (%) (number of patients with MACE/total patient number). MACE: major adverse cardiac events, BP: blood pressure.

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  Fig. 3 Two-year cumulative incidence of MACE in patients with history of hypertension (red lines) or without history of hypertension (blue lines). Values in each group are presented as MACE rate (%). MACE: major adverse cardiac events, BP: blood pressure.

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  Fig. 4 Two-year cumulative incidence of each component of MACE. CVA: cerebrovascular accident, HF: heart failure, MACE: major adverse cardiac events, BP: blood pressure.

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  Fig. 5 Odds ratio for MACE occurrence compared to the third (SBP) and the fourth (DBP) quintiles. Values in each group are presented as the odds ratio (95% confidence interval). MACE: major adverse cardiac events, BP: blood pressure, SBP: systolic blood pressure, DBP: diastolic blood pressure.

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  Fig. 6 Two-year cumulative incidence of MACE according to blood pressure range. Values in each group are presented as MACE rate (%) (number of patients with MACE/total patient number). MACE: major adverse cardiac events, BP: blood pressure.

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