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Multicenter Study
. 2025 Feb 1;43(2):246-254.
doi: 10.1097/HJH.0000000000003890. Epub 2024 Oct 11.

Impact of hypertension on mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty: insights from the international multicenter ISACS-STEMI registry

Giuseppe De Luca  1 , Matteo Nardin  2 , Magdy Algowhary  3 , Berat Uguz  4 , Dinaldo C Oliveira  5 , Vladimir Ganyukov  6 , Zan Zimbakov  7 , Miha Cercek  8 , Lisette Okkels Jensen  9 , Poay Huan Loh  10 , Lucian Calmac  11 , Gerard Roura I Ferrer  12 , Alexandre Quadros  13 , Marek Milewski  14 , Fortunato Scotto D'Uccio  15 , Clemens von Birgelen  16 , Francesco Versaci  17 , Jurrien Ten Berg  18 , Gianni Casella  19 , Aaron Wong Sung Lung  20 , Petr Kala  21 , José Luis Díez Gil  22 , Xavier Carrillo  23 , Maurits Dirksen  24 , Victor M Becerra-Munoz  25 , Michael Kang-Yin Lee  26 , Dafsah Arifa Juzar  27 , Rodrigo de Moura Joaquim  28 , Roberto Paladino  29 , Davor Milicic  30 , Periklis Davlouros  31 , Nikola Bakraceski  32 , Filippo Zilio  33 , Luca Donazzan  34 , Adriaan Kraaijeveld  35 , Gennaro Galasso  36 , Arpad Lux  37 , Lucia Marinucci  38 , Vincenzo Guiducci  39 , Maurizio Menichelli  40 , Alessandra Scoccia  41 , Aylin Hatice Yamac  42 , Kadir Ugur Mert  43 , Xacobe Flores Rios  44 , Tomas Kovarnik  45 , Michal Kidawa  46 , Josè Moreu  47 , Vincent Flavien  48 , Enrico Fabris  49 , Iñigo Lozano Martínez-Luengas  50 , Marco Boccalatte  51 , Francisco Bosa Ojeda  52 , Carlos Arellano-Serrano  53 , Gianluca Caiazzo  54 , Giuseppe Cirrincione  55 , Hsien-Li Kao  56 , Juan Sanchis Forés  57 , Luigi Vignali  58 , Helder Pereira  59 , Stephane Manzo  60 , Santiago Ordoñez  61 , Alev Arat Özkan  62 , Bruno Scheller  63 , Heidi Lehtola  64 , Rui Teles  65 , Christos Mantis  66 , Ylitalo Antti  67 , João António Brum Silveira  68 , Rodrigo Zoni  69 , Ivan Bessonov  70 , Stefano Savonitto  71 , George Kochiadakis  72 , Dimitrios Alexopulos  73 , Carlos E Uribe  74 , John Kanakakis  75 , Benjamin Faurie  76 , Gabriele Gabrielli  77 , Alejandro Gutierrez Barrios  78 , Juan Pablo Bachini  79 , Alex Rocha  80 , Frankie Chor-Cheung Tam  81 , Alfredo Rodriguez  82 , Antonia Anna Lukito  83 , Veauthyelau Saint-Joy  84 , Gustavo Pessah  85 , Guido Parodi  86 , Mohammed Abed Burgadha  87 , Elvin Kedhi  88 , Pablo Lamelas  61 , Harry Suryapranata  89 , Monica Verdoia  90
Affiliations
Multicenter Study

Impact of hypertension on mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty: insights from the international multicenter ISACS-STEMI registry

Giuseppe De Luca et al. J Hypertens. .

Abstract

Background: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.

Methods: The ISACS-STEMI COVID-19 was a retrospective registry that included STEMI patients treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 in 109 high-volume primary PCI centers from 4 continents. We collected data on baseline, clinical and procedural characteristics, in-hospital outcome and 30-day mortality. For this analysis patients were grouped according to history of hypertension at admission.

Results: A total of 16083 patients were assessed, including 8813 (54.8%) with history of hypertension. These patients were more often elderly, with a worse cardiovascular risk profile, but were less frequently active smoker. Some procedural differences were observed between the two groups, including lower rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor but more extensive coronary disease in patients with hypertension. Between patients with and without hypertension, there was no significant difference in SARS-CoV-2 positivity. Hypertensive patients had a significantly higher in-hospital and 30-day mortality, similarly observed in both pre-COVID-19 and COVID-19 era, and confirmed after adjustment for main baseline differences and propensity score (in-hospital mortality: adjusted odds ratio (OR) [95% confidence interval (CI)] =1.673 [1.389-2.014], P < 0.001; 30-day mortality: adjusted hazard ratio (HR) [95% CI] = 1.418 [1.230-1.636], P < 0.001).

Conclusion: This is one of the largest and contemporary study assessing the impact of hypertension in STEMI patients undergoing primary angioplasty, including also the COVID-19 pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-day mortality.

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