title: Impact of hypertension on distal embolization, myocardial perfusion, and mortality in patients with ST segment elevation myocardial infarction undergoing primary angioplasty.
abstract: Hypertension is a well-known risk factor for atherosclerosis. However, data on the 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 on patients undergoing primary angioplasty. The aim of the present study was to evaluate the impact of hypertension on distal embolization, myocardial perfusion, and mortality in patients with STEMI undergoing primary percutaneous coronary intervention. Our population is represented by 1,662 patients undergoing primary angioplasty for STEMI included in the Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty database. Myocardial perfusion was evaluated by myocardial blush grade and ST segment resolution. Follow-up data were collected within 1 year after primary angioplasty. Hypertension was observed in 700 patients (42.1%). Hypertension was associated with more advanced age (p <0.001), female gender (p <0.001), diabetes (p <0.001), hypercholesterolemia (p <0.001), previous revascularization (p <0.001), anterior myocardial infarction (p = 0.006), longer ischemia time (p = 0.03), more extensive coronary artery disease (p = 0.002), more often treated with abciximab (p <0.001), and less often smokers (p <0.001). Hypertension was associated with impaired postprocedural myocardial blush grade 2 to 3 (68.2% vs 74.2%, p = 0.019) and complete ST segment resolution (51.7% vs 61.1%, p = 0.001). By a mean follow-up of 206 ± 158 days, 70 patients (4.3%) had died. Hypertension was associated with a greater mortality (6.2% vs 2.9%, hazard ratio 2.31, 95% confidence interval 1.42 to 3.73, p <0.001), confirmed after correction for baseline confounding factors (hazard ratio 1.82, 95% confidence interval 1.03 to 3.22, p <0.001). In conclusion, this study showed that among patients with STEMI undergoing primary angioplasty, hypertension is associated with impaired reperfusion and independently predicts 1-year mortality.
authors.affiliation: Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van't Hof
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
authors.forename: Hans-Richard
authors.initials: HR
authors.lastname: Arntz
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
authors.forename: Simona
authors.initials: S
authors.lastname: Zorman
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: H Mesquita
authors.initials: HM
authors.lastname: Gabriel
authors.forename: Ayse
authors.initials: A
authors.lastname: Emre
authors.forename: Donald
authors.initials: D
authors.lastname: Cutlip
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Maryann
authors.initials: M
authors.lastname: Gyongyosi
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation / Q000502:physiology*; D004562:Electrocardiography; D004617:Embolism / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends