title: Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation.
abstract: We sought to investigate the effect of ward-to-cath lab blood pressure (BP) differences on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). There are limited data available on the association between PCI with DES and BP differences on long-term clinical outcomes. This study enrolled 994 patients who underwent PCI with DES from March 2003 to August 2007. Resting BP was measured in a ward environment before transfer to the cardiac catheterization lab (cath lab), and again when the patient was laid down on the cath lab table. Patients were divided into two groups according to the difference in ward-to-cath lab systolic BP. Large difference group (n = 383) was defined as the absolute systolic difference of >20 mmHg and small difference group (n = 424) as the absolute systolic difference of ≤20 mmHg. The primary endpoints were all-cause mortality, cardiac death, nonfatal myocardial infarction and stroke. A total of 807 patients (mean age 60 ± 10 years, 522 males) received follow-up for 5.1 ± 2.4 years. The rate of all-cause mortality was significantly higher in the large difference group compared to the small difference group (6.6 vs. 2.8 %; adjusted hazard ratio (HR) 2.43; 95 % confidence interval (CI) 1.22-4.83; p = 0.012). There were higher cardiac deaths seen in the large difference group compared to the small difference group (3.9 vs. 1.4 %; adjusted HR 2.84; 95 % CI 1.1-7.31; p = 0.031). Stroke (2.4 vs. 1.2 %, p = 0.125) and TVR (3.7 vs. 1.7 %, p = 0.051) had higher trends in the large difference group compared to the small difference group. The composite of primary endpoints (all-cause mortality, cardiac death, nonfatal MI and stroke) occurred more frequently in the large difference group compared to the small difference group (10.0 vs. 6.4 %; adjusted HR 1.71; 95 % CI 1.04-2.81; p = 0.033). A difference in ward-to-cath lab systolic BP of >20 mmHg may contribute to increased adverse outcomes in the form of all-cause mortality and cardiac deaths in patients undergoing PCI with DES.
authors: Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, South Korea.
authors: Ae-Young
authors: AY
authors: Her
authors: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
authors: Soe Hee
authors: SH
authors: Ann
authors: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
authors: Jun Ho
authors: JH
authors: Lee
authors: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
authors: Jong Min
authors: JM
authors: Kim
authors: Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, South Korea.
authors: Yong Hoon
authors: YH
authors: Kim
authors: East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK.
authors: Scot
authors: S
authors: Garg
authors: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
authors: Gillian Balbir
authors: GB
authors: Singh
authors: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea. ses@uuh.ulsan.kr.
authors: Eun-Seok
authors: ES
authors: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000601:surgery; D001794:Blood Pressure; D003643:Death; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000601:surgery; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D056910:Republic of Korea; D012189:Retrospective Studies; D013599:Systole; D016896:Treatment Outcome
keywords: Adverse outcomes; Blood pressure; Difference; Drug-eluting stent; Percutaneous coronary intervention