Higher blood pressure as a favourable prognostic factor for long-term outcome in acute ST-elevation myocardial infarction patients

Abstract

Background Low blood pressure (BP) may indicate more severe myocardial necrosis in patients with ST-elevation myocardial infarction (STEMI). BP value on admission has an essential influence on the following STEMI risk stratification. There are no large, Polish, prospective studies concerning risk factors for total mortality in STEMI patients treated according to the contemporary guidelines. The aim of the study was to evaluate the impact of admission BP in STEMI patients treated in tertiary cardiologic centre with 24-hour invasive cardiology on-site on long-term prognosis.
Material and methods One-centre STEMI registry analysis with one-year follow-up of 601 patients. Follow-up was taken during ambulatory visits or telephone contacts. Factors influencing one-year total mortality were evaluated in multivariate logistic regression model. The predictive value of the model was assessed with the use of area under ROC curves. Model’s goodness of fit were checked by Pearson or Hosmer-Lemeshow tests.
Results One-year total mortality was 14.8%. In follow-up only systolic BP > 130 mm Hg on admission and type of chest pain — angina pectoris de novo < 2 weeks were connected with the decreased probability of death after one year. The constructed model was characterized by both high goodness of fit and predictive values (ROC = 0.85).
Conclusions Systolic BP above median, in this registry: BP > 130 mm Hg, may be considered as the particularly favourable prognostic factor for long-term outcome in STEMI. In STEMI patients treated according to the contemporary standards, systolic BP > 130 mm Hg on admission, when compared to those below-median implicate 60% decreased risk of death after one year.