Association of Pre-PCI Blood Pressure and No-Reflow in Patients with Acute ST-Elevation Coronary Infarction

Abstract

Background: Previous studies have established blood pressure (BP) as a pivotal factor influencing no-reflow following primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute coronary infarction (STEMI). However, no relevant study has been conducted to investigate the optimal range of BP associated with the lowest risk of no-reflow among STEMI patients so far. Therefore, our objective was to evaluate the association between pre-PCI BP and the occurrence of no-reflow in patients with STEMI.

Method: We included 1025 STEMI patients undergoing primary PCI. The BP pre-PCI was categorized into 20-mmHg increments. Logistic models were employed to assess the association of no-reflow with systolic blood pressure (SBP) or diastolic blood pressure (DBP). Three sensitivity analyses were conducted to further confirm the robustness of the association between blood pressure and no-reflow.

Results: SBP or DBP exhibited a U-shaped curve association with no-reflow. No-reflow was higher in patients with lower SBP (<100 mmHg) (adjusted hazard ratio (OR) 3.64, 95% confidence interval (CI) 1.84,7.21; p < 0.001) and lower DBP (<60 mmHg) (OR 3.28, 95% CI 1.63,6.49; p < 0.001) [reference: 120 ≤SBP <140; 80 ≤DBP <100 mmHg], respectively. Furthermore, no-reflow was higher in patients with higher SBP (≥160 mmHg) (OR 2.07, 95% CI 1.27,3.36; p = 0.003) and DBP (≥100 mmHg) (OR 3.36, 95% CI 2.07,5.46; p < 0.001), respectively. The results of sensitivity analyses were consistent with the above findings.

Conclusion: Maintaining a pre-PCI SBP within the range of 120 to 140 mmHg and a DBP within the range of 80 to 100 mmHg may be confer benefits to patients with STEMI in no-reflow.

Keywords: DBP (Diastolic blood pressure); SBP (Systolic blood pressure); STEMI (ST-elevation acute coronary infarction); no-reflow.

Figure 1

The associations of blood pressure with no-reflow. A: The association between systolic blood pressure (SBP) and no-reflow; B: The association between diastolic blood pressure (DBP) and no-reflow; C: The association between systolic blood pressure (SBP) and no-reflow after adjusted; D: The association between diastolic blood pressure (DBP) and no-reflow after adjusted; Adjusted odds ratio was calculated based on the logsitic model with adjustment of gender, age, smoking history, heart rate, a number of ST elevation leads greater than 3, hypertension, diabetes, Killip classification on admission, Cardiac arrest occurred before PCI, heart failure during PCI, malignant arrhythmia during PCI, intravenous blood pressure medication before PCI, Thrombus-shadow during coronary angiogram, Lesion-vessel number, Number of stents, oral blood pressure, and medication before PCI. The 95% confidence intervals were represented by shaded regions. Abbreviations: CI, confidence interval; SBP, systolic blood pressure; DBP, diastolic blood pressure; OR, odds ratio. PCI, percutaneous transluminal coronary intervention.