Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES Insights from the DESERT cooperation

• Published in: International journal of cardiology Vol. 175; no. 1; pp. 50 - 54
• Main Authors: DE LUCA, Giuseppe, DIRKSEN, Maurits T, CHECHI, Tania, SPAZIANI, Gaia, DE LA LLERA, Luis Salvador Diaz, PASCERI, Vincenzo, DI LORENZO, Emilio, VIOLINI, Roberto, SURYAPRANATA, Harry, STONE, Gregg W, SPAULDING, Christian, KELBAEK, Henning, SCHALIJ, Martin, THUESEN, Leif, VAN DER HOEVEN, Bas, VINK, Marteen A, KAISER, Christoph, MUSTO, Carmine
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier 15.07.2014
• Subjects: Aged; Angioplasty, Balloon, Coronary - mortality; Angioplasty, Balloon, Coronary - trends; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary heart disease; Diseases of the cardiovascular system; Drug-Eluting Stents - trends; Female; Follow-Up Studies; Heart; Humans; Hypertension - diagnosis; Hypertension - mortality; Hypertension - surgery; Male; Medical sciences; Metals; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocarditis. Cardiomyopathies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic - mortality; Randomized Controlled Trials as Topic - trends; Treatment Outcome; Human; Hypertension; Myocardial infarction; Prognosis; Angioplasty; Primary angioplasty; ST elevation myocardial infarction; Instrumentation therapy; Patient; Cardiovascular disease; BMS; Instrumental dilatation; Coronary heart disease; Myocardial disease; Knowledge; ST elevation; DES; Cooperation; Primary; Evolution; Desert; Cardiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.04.180

Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES. Our population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI. Hypertension was observed in 2764 patients (43.9%), and associated with ageing (p<0.0001), female gender (p<0.001), diabetes (p<0.0001), hypercholesterolemia (p<0.0001), previous MI (p=0.002), previous revascularization (p=0.002), longer time-to-treatment (p<0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p<0.001) and anterior MI (42% vs 45.9%, p=0.002). Hypertension was associated with impaired postprocedural TIMI 0-2 flow (Adjusted OR [95% CI]=1.22 [1.01-1.47], p=0.034). At a follow-up of 1,201 ± 440 days, hypertension was associated with higher mortality (adjusted HR [95% CI]=1.24 [1.01-1.54], p=0.048), reinfarction (adjusted HR [95% CI]=1.31 [1.03-1.66], p=0.027), stent thrombosis (adjusted HR [95% CI]=1.29 [0.98-1.71], p=0.068) and TVR (adjusted HR [95% CI]=1.22 [1.04-1.44], p=0.013). This study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher ST.