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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Division of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it.
Giuseppe
G
De Luca
Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Maurits T
MT
Dirksen
Assistance Publique-Hopitaux de Paris Cochin Hospital, Paris 5 Medical School Rene Descartes University and INSERM Unite 780 Avenir, Paris, France.
Christian
C
Spaulding
The Heart Center, Rigshospitalet, Copenhagen, Denmark.
Henning
H
Kelbæk
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Martin
M
Schalij
Cardiac Department, Skejby Hospital, Skejby, Denmark.
Leif
L
Thuesen
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Bas
B
van der Hoeven
Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Marteen A
MA
Vink
Department of Cardiology, University Hospital Basel, Switzerland.
Christoph
C
Kaiser
Division of Cardiology, San Camillo Hospital, Rome, Italy.
Carmine
C
Musto
Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy.
Tania
T
Chechi
Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy.
Gaia
G
Spaziani
Hemodynamics and Interventional Cardiology Unit, University Hospital Virgen del Rocio, Seville, Spain.
Luis Salvador
LS
Diaz de la Llera
Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy.
Vincenzo
V
Pasceri
Division of Cardiology, "S.G. Moscati", Avellino, Italy.
Emilio
E
Di Lorenzo
Division of Cardiology, San Camillo Hospital, Rome, Italy.
Roberto
R
Violini
Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands.
Harry
H
Suryapranata
Columbia University Medical Center, New York City, NY, USA; Cardiovascular Research Foundation, New York City, NY, USA.
Gregg W
GW
Stone
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality* / Q000639:trends; D054855:Drug-Eluting Stents / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000401:mortality / Q000639:trends; D016896:Treatment Outcome
D008670:Metals
BMS; DES; Hypertension; Primary angioplasty; ST elevation myocardial infarction