title: Prognostic Significance of Presenting Blood Pressure in Patients With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.
abstract: BACKGROUND
  We evaluated the impact of normal vs. high presenting blood pressure (BP) on clinical outcomes and cardiac function in patients with ST-elevation myocardial infarction (MI).
  
  
  METHODS
  In 11,292 patients, in-hospital mortality and major adverse clinical events (MACE; all-cause death, nonfatal MI, or any revascularization) during follow-up were compared between patients with normal (≥ 100 mm Hg and ≤ 139 mm Hg) and high (≥ 140 mm Hg) systolic BP at presentation.
  
  
  RESULTS
  Compared to patients with high BP, patients with normal BP had significantly higher in-hospital mortality (1.5% vs. 3.7%; P < 0.001), especially in those with prior hypertension, and higher rates of all-cause death (3.3% vs. 5.3%; P < 0.001) and MACE (9.8% vs. 11.8%; P = 0.04) during follow-up (median: 330 days). After multivariate adjustment, normal BP was associated with higher risk of in-hospital mortality (adjusted hazard ratio (HR) = 2.268; 95% confidence interval (CI) = 1.144-4.498; P = 0.019), but not all-cause death (adjusted HR = 0.956; 95% CI = 0.602-1.517) or MACE (adjusted HR = 0.935; 95% CI = 0.755-1.158). Left ventricular ejection fraction at baseline and follow-up was significantly lower in patients with normal BP (52% vs. 51%; P < 0.001 and 55% vs. 54%; P = 0.018, respectively).
  
  
  CONCLUSIONS
  Our findings indicate that patients with normal presenting BP, especially those with prior hypertension, exhibit higher in-hospital mortality and poorer cardiac function compared to patients with high BP. Although outcomes during follow-up did not differ, cardiac function was persistently poorer in patients who presented with normal BP.
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Jin Sup
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea; cks@pusan.ac.kr.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Donghun
authors.initials: D
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Dae Sung
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Jun-Hyok
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Han Cheol
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea;
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea;
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea;
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea;
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea;
authors.forename: June Hong
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea;
authors.forename: Kook-Jin
authors.initials: KJ
authors.lastname: Chun
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea;
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea;
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea;
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination / Q000379:methods / Q000706:statistics & numerical data; D002423:Cause of Death; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D013318:Stroke Volume
keywords: acute myocardial infarction; blood pressure; cardiac function; hypertension; percutaneous coronary intervention; presenting blood pressure.