Change in pulse pressure and cardiovascular outcomes after percutaneous coronary intervention: The CLIDAS study

Kotaro Nochioka¹, Masaharu Nakayama², Naoyuki Akashi³, Tetsuya Matoba⁴, Takahide Kohro⁵, Yusuke Oba⁶, Tomoyuki Kabutoya⁶, Yasushi Imai⁷, Kazuomi Kario⁶, Arihiro Kiyosue⁸, Yoshiko Mizuno^{8

9}, Takamasa Iwai¹⁰, Yoshihiro Miyamoto¹¹, Masanobu Ishii¹², Taishi Nakamura¹³, Kenichi Tsujita¹², Hisahiko Sato¹⁴, Hideo Fujita³, Ryozo Nagai¹⁵; CLIDAS research group

Affiliations

¹ Division of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1, Aoba-ku, Sendai 981-0933, Japan.
² Department of Medical Informatics, Tohoku University Graduate School of Medicine, 1-1-1 Seiryo-machi, Aoba-ku, Sendai 981-0933, Japan.
³ Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan.
⁴ Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
⁵ Department of Clinical Informatics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
⁶ Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
⁷ Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
⁸ Department of Cardiovascular Medicine, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
⁹ Development Bank of Japan Inc., 1-9-6 Otemachi, Chiyoda-ku, Tokyo 100-8178, Japan.
¹⁰ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita 564-8565, Japan.
¹¹ Open Innovation Center, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita 564-8565, Japan.
¹² Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
¹³ Department of Cardiovascular Medicine, Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
¹⁴ Precision Inc., 4-2-5 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
¹⁵ Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.

PMID: 39228973
PMCID: PMC11368593
DOI: 10.1016/j.ijcha.2024.101430

Change in pulse pressure and cardiovascular outcomes after percutaneous coronary intervention: The CLIDAS study

Kotaro Nochioka et al. Int J Cardiol Heart Vasc. 2024.

. 2024 May 24:53:101430.

doi: 10.1016/j.ijcha.2024.101430. eCollection 2024 Aug.

Authors

Affiliations

¹ Division of Cardiovascular Medicine, Tohoku University Hospital, Seiryo-machi 1-1, Aoba-ku, Sendai 981-0933, Japan.
² Department of Medical Informatics, Tohoku University Graduate School of Medicine, 1-1-1 Seiryo-machi, Aoba-ku, Sendai 981-0933, Japan.
³ Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan.
⁴ Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
⁵ Department of Clinical Informatics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
⁶ Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
⁷ Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
⁸ Department of Cardiovascular Medicine, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
⁹ Development Bank of Japan Inc., 1-9-6 Otemachi, Chiyoda-ku, Tokyo 100-8178, Japan.
¹⁰ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita 564-8565, Japan.
¹¹ Open Innovation Center, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita 564-8565, Japan.
¹² Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
¹³ Department of Cardiovascular Medicine, Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
¹⁴ Precision Inc., 4-2-5 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
¹⁵ Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.

PMID: 39228973
PMCID: PMC11368593
DOI: 10.1016/j.ijcha.2024.101430

Abstract

Background: Limited data exist on the prognostic value of changes in pulse pressure (PP, the difference between systolic and diastolic blood pressure) during hospitalization for patients with coronary artery disease who have undergone percutaneous coronary intervention (PCI).

Methods: In the Clinical Deep Data Accumulation System (CLIDAS), we studied 8,708 patients who underwent PCI. We aimed to examine the association between discharge PP and cardiovascular outcomes. PP was measured before PCI and at discharge. Patients were divided into five groups (quintiles) based on the change in PPQ1 (-18.0 ± 9.9 mmHg), Q2 (-3.8 ± 2.6), Q3 (reference; 3.7 ± 2.0), Q4 (11.3 ± 2.6), and Q5 (27.5 ± 11.2). We then analyzed the relationship between PP change and outcomes.

Results: The mean patient age was 70 ± 11 years, with 6,851 (78 %) men and 3,786 (43 %) having acute coronary syndrome. U-shaped relationships were observed for the incidence rates of major adverse cardiac or cerebrovascular events (MACCE, a composite endpoint of cardiovascular death, myocardial infarction, and stroke), revascularization, and hospitalization for heart failure (HF). After adjusting for confounding factors, higher PP at discharge was associated with an increased risk of MACCE (adjusted hazard ratio 1.41; 95 %CI, 1.06-1.87 in Q5 [73.9 ± 9.3 mmHg]). Evaluating PP change revealed a U-shaped association with MACCE (1.50; 1.11-2.02 in Q1 and 1.47; 0.98-2.20 in Q5). Additionally, Q5 had a higher risk for hospitalization for HF (1.37; 1.00-1.88).

Conclusions: Our findings demonstrate a U-shaped association between changes in PP and cardiovascular outcomes. This data suggests the significance of blood pressure control during hospitalization for patients who have undergone PCI.

Keywords: Coronary artery disease; Prognosis; Pulse pressure.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: TK has received scholarship funding from Abbott. KK has received a research grant from Otsuka Pharmaceutical, Sanwa Kagaku Kenkyusho, Daiichi Sankyo, MSD, Astellas Pharma, Eisai, Taisho Pharmaceutical, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma, Teijin Pharma, Boehringer Ingelheim Japan, Bristol-Myers Squibb, Mochida Pharmaceutical; Consulting fees from Kyowa Kirin, Sanwa Kagaku Kenkyusho, Mochida Pharmaceutical; Honoraria from Otsuka Pharmaceuticals, Daiichi Sankyo, Novartis Pharma, Mylan EPD; Participation in Advisory Board of Daiichi Sankyo, Novartis Pharma. HF received scholarship funds from Abbott Vascular, speaking honoraria from Novartis and Otsuka Pharmaceutical Co., Ltd., and served as a consultant for Mehergen Group Holdings, Inc. KT has received personal fees from Abbott Medical Co., Ltd., personal fees from Amgen K.K., personal fees from AstraZeneca K.K., personal fees from Bayer Yakuhin, Ltd., personal fees from Daiichi Sankyo Co., Ltd., personal fees from Medtoronic Japan Co., Ltd., personal fees from Kowa Pharmaceutical Co. Ltd., personal fees from Novartis Pharma K.K., personal fees from Otsuka Pharmaceutical Co.,Ltd., personal fees from Pfizer Japan Inc., personal fees from Janssen Pharmaceutical K.K., grants from PPD-Shin Nippon Biomedical Laboratories K.K., grants from Alexion Pharmaceuticals, Inc., grants from Abbott Medical Co., Ltd., grants from Bayer Yakuhin, Ltd., grants from Boehringer Ingelheim Japan, grants from Daiichi Sankyo Co., Ltd., grants from ITI Co.,Ltd., grants from ONO PHARMACEUTICAL CO., LTD., grants from Otsuka Pharmaceutical Co.,Ltd., grants from Takeda Pharmaceutical Co., Ltd., other from Abbott Japan Co., Ltd., other from Boston Scientific Japan K.K., other from Fides-one, Inc., other from GM Medical Co., Ltd., other from ITI Co.,Ltd., other from Kaneka Medix Co., Ltd., other from NIPRO CORPORATION, other from TERUMO Co, Ltd., other from Abbott Medical Co., Ltd., other from Boston Scientific Japan K.K., other from Cardinal Health Japan, other from Fukuda Denshi Co., Ltd., other from Japan Lifeline Co.,Ltd., other from Medical Appliance Co., Ltd., other from Medtronic Japan Co., Ltd., outside the submitted work. TM has received lecture fees (Abbott, Bayer Yakuhin, and MSD) and research funding (Amgen, Bayer Yakuhin, and Kowa). YM received research funds from Kowa Company, Ltd., within the submitted work and from Tokyo Marine and Nichido Fire Insurance Co., Ltd., Fujitsu Co., Ltd., Softbank Co., Ltd., Saraya Co., Ltd., and Meiji Yasuda Life Insurance Company outside of the submitted work.

Figures

**Fig. 1**
Incidence rates per 1,000 person-years of (A) major adverse cardiac or cerebrovascular event [MACCE; defined as a composite of cardiovascular (CV) death, myocardial infarction (MI), and stroke], (B) revascularization, and (C) hospitalization for heart failure (HF) across changes in pulse pressure (ΔPP). ΔPP is calculated by subtracting blood pressure at discharge from the blood pressure at hospitalization. The solid line represents the incidence rate, and the dashed lines represent the 95% confidence intervals.

See this image and copyright information in PMC

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Change in pulse pressure and cardiovascular outcomes after percutaneous coronary intervention: The CLIDAS study

Affiliations

Change in pulse pressure and cardiovascular outcomes after percutaneous coronary intervention: The CLIDAS study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials

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