Antecedent hypertension and myocardial injury in patients with reperfused ST-elevation myocardial infarction.
BACKGROUND
Antecedent hypertension is associated with poor outcome in patients with ST-elevation myocardial infarction (STEMI). Whether differences in myocardial salvage, infarct size and microvascular injury contribute to the adverse outcome is unknown. We investigated the association between antecedent hypertension and cardiovascular magnetic resonance (CMR) parameters of myocardial salvage and damage in a multicenter CMR substudy of the AIDA-STEMI trial (Abciximab Intracoronary versus intravenously Drug Application in ST-elevation myocardial infarction).


METHODS
We analyzed 792 consecutive STEMI patients reperfused within 12 h after symptom onset. Patients underwent CMR imaging for assessment of myocardial salvage, infarct size and microvascular obstruction within 10 days after infarction. Major adverse cardiac events (MACE) were recorded at 12-month follow-up.


RESULTS
Antecedent hypertension was present in 540 patients (68 %) and was associated with a significantly increased baseline risk profile (advanced age, higher body mass index, higher incidence of diabetes, hypercholesterolemia, previous angioplasty and multivessel disease, p < 0.001 for all). MACE were more frequent in patients with hypertension as compared to patients without hypertension (45 [8 %] vs. 8 [3 %], p < 0.01). Antecedent hypertension remained an independent predictor of MACE after multivariate adjustment (hazard ratio 3.42 [confidence interval 1.45-8.08], p < 0.01). There was, however, no significant difference in the area at risk, infarct size, myocardial salvage index, extent of microvascular obstruction, and left ventricular ejection fraction between the groups (all p > 0.05).


CONCLUSIONS
Despite a higher rate of MACE in contemporary reperfused STEMI patients with antecedent hypertension, there was no difference in reperfusion efficacy, infarct size and reperfusion injury as visualized by CMR.


BACKGROUND
NCT00712101 .
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
Sebastian J
SJ
Reinstadler
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Thomas
T
Stiermaier
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Charlotte
C
Eitel
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Mohammed
M
Saad
University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
Bernhard
B
Metzler
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Suzanne
S
de Waha
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Georg
G
Fuernau
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Steffen
S
Desch
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Holger
H
Thiele
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. ingoeitel@gmx.de.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. ingoeitel@gmx.de.
Ingo
I
Eitel
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab
Cardiovascular magnetic resonance; Hypertension; Major adverse cardiac events; ST-elevation myocardial infarction