title: Low DBP may not be an independent risk for cardiovascular death in revascularized coronary artery disease patients.
abstract: OBJECTIVE
  It remains controversial whether extremely low DBP is a risk for cardiovascular events in patients with coronary artery disease (CAD). Coronary revascularization therapy became prevalent in CAD patients. We sought to determine the impact of low DBP on cardiovascular events and to investigate the predicting factors in revascularized CAD patients.
  
  
  METHODS
  We subanalyzed 7180 stable, chronic CAD patients (median follow-up period 3.6 years) of 9877 patients undergoing first coronary artery bypass graft or percutaneous coronary intervention in the registry of the Coronary REvascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto).
  
  
  RESULTS
  Kaplan-Meier analysis revealed that unadjusted cumulative incidence of cardiovascular death was greater in patients with preprocedural DBP of less than 70 mmHg than in those with DBP of at least 70 mmHg, whereas the cumulative incidences of nonfatal myocardial infarction (MI) and of stroke were similar between the two groups. Stepwise logistic regression analysis showed that estimated glomerular filtration ratio (inversely), pulse pressure, left ventricular ejection fraction of less than 0.40, history of heart failure, prior cerebrovascular disease, and prior MI were independent risks for cardiovascular death in patients with DBP of less than 70 mmHg. After adjustments for the independent risks, the cumulative hazard ratio for cardiovascular death did not differ between patients with DBP of less than 70 mmHg and those with DBP of at least 70 mmHg.
  
  
  CONCLUSIONS
  Renal insufficiency, more advanced vascular damage, and left ventricular systolic dysfunction were significant factors accounting for increased cardiovascular death in revascularized CAD patients with DBP of less than 70 mmHg. It was suggested that after adjustments for these independent risks, low DBP may not be a significant risk for cardiovascular death in revascularized CAD patients.
authors.affiliation: Division of Cardio-vascular Medicine, Department of Internal Medicine, Kurume, Japan. naikai@med.kurume-u.ac.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kai
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ueno
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Hisashi
authors.initials: H
authors.lastname: Adachi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Imaizumi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000628:therapy*; D003971:Diastole; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology