Prognostic value of pulse pressure after an acute coronary syndrome.

Harbaoui, Brahim; Nanchen, David; Lantelme, Pierre; Gencer, Baris; Heg, Dick; Klingenberg, Roland; Räber, Lorenz; Carballo, David; Matter, Christian M; Windecker, Stephan; Mach, François; Rodondi, Nicolas; Eeckhout, Eric; Monney, Pierre; Antiochos, Panagiotis; Schwitter, Juerg; Pascale, Patrizio; Fournier, Stephane; Courand, Pierre-Yves; Lüscher, Thomas F; ... (2018). Prognostic value of pulse pressure after an acute coronary syndrome. Atherosclerosis, 277, pp. 219-226. Elsevier 10.1016/j.atherosclerosis.2018.07.013

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BACKGROUND AND AIMS Pulse pressure (PP) is a surrogate of aortic stiffness (AS) easily obtainable. The link between AS and cardio-vascular disease is documented, however, data regarding acute coronary syndrome (ACS) patients are scarce and contradictory. We aimed to assess the prognostic value of PP measured at admission, with regard to major adverse outcomes (all-cause mortality, recurrence of MI, and stroke), during the first year following an acute coronary syndrome (ACS). METHODS The SPUM-ACS project is a prospective cohort study of patients with ACS conducted in 4 Swiss University hospitals. Patients with no PP at admission or with severe clinical heart failure or cardiogenic shock were excluded. Cox regression analyses were performed to determine associations between PP and outcomes (all-cause mortality, recurrence of myocardial infarction (MI), and stroke). Three multivariate Cox regression models were adjusted for hemodynamic, cardiovascular, and non-cardiovascular confounders, added successively. RESULTS Of 5635 eligible patients, 5070 met the inclusion criteria. Mean patient age was 63 years (range: 54-72), 79.6% were male, and mean blood pressure and PP were 93.9 ± 15.6 and 54 ± 17 mmHg, respectively. Multivariate analyses confirmed the prognostic significance of PP for each 10-mmHg increase for the composite endpoint, hazard ratio (HR) 1.126 [1.051-1.206], p = 0.001; all-cause mortality, HR1.129 [1.013-1.260], p = 0.029; and recurrence of MI, HR1.206 [1.102-1.320], p < 0.001; but not for stroke, HR1.014[0.853-1.205]. CONCLUSIONS PP measured at admission is a strong, independent prognostic marker predicting mortality and recurrence of MI after ACS. PP should be considered for the management of secondary prevention.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Heg, Dierik Hans; Räber, Lorenz; Windecker, Stephan and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0021-9150

Publisher:

Elsevier

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

14 Aug 2018 16:42

Last Modified:

14 Feb 2019 11:40

Publisher DOI:

10.1016/j.atherosclerosis.2018.07.013

PubMed ID:

30033338

Uncontrolled Keywords:

Acute coronary syndrome Aortic stiffness Cardiovascular events Prognosis Pulse pressure

BORIS DOI:

10.7892/boris.118967

URI:

https://boris.unibe.ch/id/eprint/118967

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