title: Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome.
abstract: BACKGROUND
  The association between admission pulse pressure (PP) and cardiovascular outcomes in acute coronary syndrome (ACS) is not well defined.
  
  
  OBJECTIVE
  To explore the prognostic value of initial PP in ST-segment elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTE-ACS).
  
  
  METHODS
  Over a 5-month period in 2007, 6704 consecutive patients with ACS were categorized into five groups according to initial PP: P1, PP ≤0; P2, PP 31-40; P3, PP 41-50; P4, PP 51-60; P5, PP>60mmHg. Patient characteristics and in-hospital outcomes were analysed.
  
  
  RESULTS
  Mean PP was lower in men versus women (55±19 vs. 61±22), young versus old (53±17 vs. 59±21), STEMI vs. NSTE-ACS (51±18 vs. 60±18) and patients who died versus survived (46±22 vs. 57±19mmHg) (P<0.001 for all). Most patients with low PP had a high Global Registry of Acute Coronary Events risk score. Compared with P5, crude odds ratios (ORs) (95% confidence intervals) for death were: P1, 9 (5.78-13.35); P2, 3 (1.71-4.06); P3, 1.5 (1.01-2.49); P4, 0.90 (0.51-1.58). After adjustment, low PP was associated with high mortality and stroke rates in ACS (adjusted ORs 7.5 [3.77-14.72] and 4.5 [1.20-18.88], respectively), high rates of recurrent ischaemia in NSTE-ACS (adjusted OR 2.8 [1.52-5.22]) and a high heart failure rate in STEMI (adjusted OR 2.1 [1.18-3.76]). Women with low PP had a higher mortality rate than men.
  
  
  CONCLUSIONS
  In ACS, all blood pressure variables were significantly correlated. Low PP was an independent predictor for stroke and mortality in overall ACS. Although PP was not superior to systolic blood pressure, only low PP was an independent predictor for recurrent ischaemia in NSTE-ACS.
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital (HMC), Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Zubaid
authors.forename: Wael
authors.initials: W
authors.lastname: Almahmeed
authors.forename: Muath
authors.initials: M
authors.lastname: Alanbaei
authors.forename: Wafa
authors.initials: W
authors.lastname: Rashed
authors.forename: Awad
authors.initials: A
authors.lastname: Al Qahtani
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.forename: Shahid
authors.initials: S
authors.lastname: Zubair
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors