Association of Pre-PCI Blood Pressure and No-Reflow in Patients with Acute ST-Elevation Coronary Infarction

Overview

Journal Glob Heart

Publisher Ubiquity Press

Specialty Cardiology & Vascular Diseases

Date 2024 Mar 11

PMID 38464557

Authors

Xiaobo Li

Chen Yu

Li Lei

Xuewei Liu

Yejia Chen

Yutian Wang

Shifeng Qiu

Jiancheng Xiu

Affiliations

Soon will be listed here.

Abstract

Background: Previous studies have established blood pressure (BP) as a pivotal factor influencing no-reflow following primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute coronary infarction (STEMI). However, no relevant study has been conducted to investigate the optimal range of BP associated with the lowest risk of no-reflow among STEMI patients so far. Therefore, our objective was to evaluate the association between pre-PCI BP and the occurrence of no-reflow in patients with STEMI.

Method: We included 1025 STEMI patients undergoing primary PCI. The BP pre-PCI was categorized into 20-mmHg increments. Logistic models were employed to assess the association of no-reflow with systolic blood pressure (SBP) or diastolic blood pressure (DBP). Three sensitivity analyses were conducted to further confirm the robustness of the association between blood pressure and no-reflow.

Results: SBP or DBP exhibited a U-shaped curve association with no-reflow. No-reflow was higher in patients with lower SBP (<100 mmHg) (adjusted hazard ratio (OR) 3.64, 95% confidence interval (CI) 1.84,7.21; p < 0.001) and lower DBP (<60 mmHg) (OR 3.28, 95% CI 1.63,6.49; p < 0.001) [reference: 120 ≤SBP <140; 80 ≤DBP <100 mmHg], respectively. Furthermore, no-reflow was higher in patients with higher SBP (≥160 mmHg) (OR 2.07, 95% CI 1.27,3.36; p = 0.003) and DBP (≥100 mmHg) (OR 3.36, 95% CI 2.07,5.46; p < 0.001), respectively. The results of sensitivity analyses were consistent with the above findings.

Conclusion: Maintaining a pre-PCI SBP within the range of 120 to 140 mmHg and a DBP within the range of 80 to 100 mmHg may be confer benefits to patients with STEMI in no-reflow.

References

Ettehad D, Emdin C, Kiran A, Anderson S, Callender T, Emberson J . Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387(10022):957-967. DOI: 10.1016/S0140-6736(15)01225-8. View

Hao Y, Liu J, Liu J, Smith Jr S, Huo Y, Fonarow G . Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome. Am Heart J. 2016; 179:107-15. DOI: 10.1016/j.ahj.2016.06.005. View

Lip S, Tan L, Jeemon P, McCallum L, Dominiczak A, Padmanabhan S . Diastolic Blood Pressure J-Curve Phenomenon in a Tertiary-Care Hypertension Clinic. Hypertension. 2019; 74(4):767-775. PMC: 6756261. DOI: 10.1161/HYPERTENSIONAHA.119.12787. View

Ito H, Maruyama A, Iwakura K, Takiuchi S, Masuyama T, Hori M . Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation. 1996; 93(2):223-8. DOI: 10.1161/01.cir.93.2.223. View

Chandrashekhar Y, Alexander T, Mullasari A, Kumbhani D, Alam S, Alexanderson E . Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Low- and Middle-Income Countries. Circulation. 2020; 141(24):2004-2025. DOI: 10.1161/CIRCULATIONAHA.119.041297. View

de Waha S, Patel M, Granger C, Ohman E, Maehara A, Eitel I . Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials. Eur Heart J. 2017; 38(47):3502-3510. DOI: 10.1093/eurheartj/ehx414. View

Antoni M, Boden H, Delgado V, Boersma E, Fox K, Schalij M . Relationship between discharge heart rate and mortality in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Eur Heart J. 2011; 33(1):96-102. DOI: 10.1093/eurheartj/ehr293. View

Galiuto L, Rebuzzi A, Crea F . The no-reflow phenomenon. JACC Cardiovasc Imaging. 2009; 2(1):85-6. DOI: 10.1016/j.jcmg.2008.11.003. View

Huang L, Zhang J, Huang Q, Cui R, Chen J . In-hospital major adverse cardiovascular events after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: a retrospective study under the China chest pain center (standard center) treatment.... BMC Cardiovasc Disord. 2023; 23(1):198. PMC: 10111847. DOI: 10.1186/s12872-023-03214-x. View

10.

Duncker D, Koller A, Merkus D, Canty Jr J . Regulation of coronary blood flow in health and ischemic heart disease. Prog Cardiovasc Dis. 2014; 57(5):409-22. PMC: 5856234. DOI: 10.1016/j.pcad.2014.12.002. View

11.

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

12.

Srinivasan M, Rihal C, Holmes D, Prasad A . Adjunctive thrombectomy and distal protection in primary percutaneous coronary intervention: impact on microvascular perfusion and outcomes. Circulation. 2009; 119(9):1311-9. DOI: 10.1161/CIRCULATIONAHA.108.831453. View

13.

Gibson C, Cannon C, Daley W, Dodge Jr J, Alexander Jr B, MARBLE S . TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5):879-88. DOI: 10.1161/01.cir.93.5.879. View

14.

Bohm M, Ferreira J, Mahfoud F, Duarte K, Pitt B, Zannad F . Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial. Eur Heart J. 2020; 41(17):1673-1683. DOI: 10.1093/eurheartj/ehaa132. View

15.

Messerli F, Mancia G, Conti C, Hewkin A, Kupfer S, Champion A . Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous?. Ann Intern Med. 2006; 144(12):884-93. DOI: 10.7326/0003-4819-144-12-200606200-00005. View

16.

Neumann F, Sousa-Uva M, Ahlsson A, Alfonso F, Banning A, Benedetto U . 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2):87-165. DOI: 10.1093/eurheartj/ehy394. View

17.

Lefer A, Tsao P, Aoki N, Palladino Jr M . Mediation of cardioprotection by transforming growth factor-beta. Science. 1990; 249(4964):61-4. DOI: 10.1126/science.2164258. View

18.

Annibali G, Scrocca I, Aranzulla T, Meliga E, Maiellaro F, Musumeci G . "No-Reflow" Phenomenon: A Contemporary Review. J Clin Med. 2022; 11(8). PMC: 9028464. DOI: 10.3390/jcm11082233. View

19.

Schwartz B, Kloner R . Coronary no reflow. J Mol Cell Cardiol. 2011; 52(4):873-82. DOI: 10.1016/j.yjmcc.2011.06.009. View

20.

Niccoli G, Burzotta F, Galiuto L, Crea F . Myocardial no-reflow in humans. J Am Coll Cardiol. 2009; 54(4):281-92. DOI: 10.1016/j.jacc.2009.03.054. View