title: Prognostic Significance of Central Pulse Pressure for Mortality in Patients With Coronary Artery Disease Receiving Repeated Percutaneous Coronary Intervention.
abstract: Coronary artery disease (CAD) is a life-threatening medical emergency which needs urgent medical attention. Percutaneous coronary intervention (PCI) is common and necessary for patients with CAD, but it has not completely evaluated in cases with repeated PCI. Therefore, the aim of this study was to examine the risk factors and prognosis in patients with CAD requiring repeated PCI. This is a prospective observational study. A total of 1126 patients with CAD requiring PCI took part in this study. Clinical parameters including baseline characteristics, hemodynamic data, location of vascular lesions, SYNTAX score, left ventricular ejection fraction, central pulse pressure (CPP), central aortic systolic pressure (CSP), risk factors, and invasive strategies were analyzed to identify the risk factors for patients requiring repeated PCI. We further analyzed the prognosis, including risk for myocardial infarction (MI), cardiovascular (CV) mortality, and all-cause mortality, in patients with repeated PCI. Among patients with PCI, 276 received repeated PCI. Patients in the repeated PCI group had a higher CPP (66.7 vs 62.5 mm Hg; P = 0.006), CSP (139.9 vs 135.9 mm Hg; P = 0.017), and male preponderance (P = 0.012). Drugs including diuretics, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and aspirin were all used more frequently in the repeated PCI group (all P < 0.05). Freedom from MI was lower in the repeated PCI group than in the single PCI group (P < 0.001). Logistic regression revealed that CPP, CSP, number of diseased vessels, male sex, usage of diuretics, BBs, ACEIs, and MI were all predictors for requiring repeated PCI (all P < 0.05). In addition, CPP was a predictor for MI attack, CV mortality, and all-cause mortality in the repeated PCI group (P = 0.010, P = 0.041, P = 0.004, respectively). Elevated CPP, CSP, male sex, multiple diseased vessels, and the usage of diuretics, BBs, ACEIs, and MI were predictors for repeated PCI. Most importantly, CPP was strongly associated with MI attack, CV mortality, and all-cause mortality, and could serve as a prognostic parameter for mortality in patients with CAD after performing repeated PCI.
authors.affiliation: From the Institue of Medicine(M-JL,C-SL),Chung-Shan Medical University, Taichung;Division of Cardiology (M-JL,H-DL), Department of Medicine, Taichung Tzu-Chi Hospital,the Buddhist Tzu-Chi Medical Foundation,Taichung; Department of Medicine (M-JL), School of Medicine, Tzu Chi University, Hualien; Division of Emergency Medicine (C-YC), Department of Pediatrics, Changhua Christian Hospital, Changhua; School of Medicine (C-YC), Kaohsiung Medical University, Kaohsiung; School of Medicine (C-YC, C-SL), Chung-Shan Medical University; Department of Internal Medicine (C-SL), Chung-Shan Medical University Hospital, Taichung; Division of Pediatric General Medicine (H-PW), Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan; and College of Medicine (H-PW), Chang Gung University, Taoyuan, Taiwan, China.
authors.forename: Mao-Jen
authors.initials: MJ
authors.lastname: Lin
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Hau-De
authors.initials: HD
authors.lastname: Lin
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lin
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
mesh_terms: D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D001786:Blood Glucose; D002317:Cardiovascular Agents; D008055:Lipids