P4615Pulse pressure: an independent predictor of in-hospital cardiovascular mortality in acute coronary syndrome

Abstract

Introduction: Pulse pressure (PP) is an easily accessible parameter and has been positivity associated with arterial stiffness and negatively with cardiac performance. Therefore, PP may potentially be a marker of clinical severity in acute coronary syndromes (ACS). Aim(s): Evaluate the prognostic impact of admission PP in patients admitted by ACS. Method(s): We retrospectively analyzed 2615 patients admitted to our coronary care unit with ACS. Regarding admission PP, two groups of analysis were created using the median as a cut-off point: group 1 (PP <50mmHg, N=1270) and group 2 (>=50 mmHg, N=1345). Clinical and laboratory features, treatment and adverse events were recorded. The primary endpoint was in-hospital cardiovascular (IHCV) mortality. Result(s): Patients with lower PP (group 1), were younger (61.4+/-13.4 vs 66,1+/-12.3 years, p<0.001), more frequently male (80.0 vs 75.4%, p<0.001), with lower prevalence of diabetes type 2 (22.3 vs 32.4%, p=0.007), dyslipidemia (53 vs 59%, p=0.003), hypertension (56.4 vs 71.0%, p<0.001), obesity (IMC 27.0+/-4.5 vs 27.5+/-4.3 kg/m2 p=0.002), previous ACS (13.5 vs 16.7%, p=0.018), peripheral artery disease (3.1 vs 4.6%, p=0.04) and presented higher prevalence of smoking (35.2 vs 25.4%, p<0.001). Patients of group 1 were less medicated with aspirin (19.8 vs 30.1%, p<0.001), statin (31.4 vs 41.7%, p<0.001), ACE/ARB (34.6 vs 47.7%, p<0.001), beta-blocker (18.6 vs 24.9%, p<0.001), calcium channel blocker (14.9 vs 24.0%, p<0.001) and diuretic (20.7 vs 25.9%, p<0.001). Patients in group 1 presented at admission with lower systolic (112.2+/-17.0 vs 147.5+/-22.6 mmHg, p<0.001) and diastolic (75.0+/-14.5 vs 80.6+/-16.0 mmHg, p<0.001) pressures, lower heart rate (75.8+/-18.1 vs 77.1+/-17.7 bpm, p<0.001) and higher GFRe MDRD (85.6+/-31.1 vs 83.0+/-33.0 mL/min/1.73m2, p=0.048). Lower PP was also associated with worse clinical course, with lower LV contractility, ejection fraction (EF) (43.9 vs 46.7%, p<0.001), higher troponin I peak (62.2+/-105.1 vs 44.0+/-77.2 ng/mL, p<0.001), prevalence of ST-segment elevation myocardial infarction (STEMI) (54.7 vs 41.0%, p<0.001), cardiogenic shock (8.1 vs 2.0%, p<0.001), inotropic/vasopressor support (9.6 vs 3.3%, p<0.001) and IH-CV mortality (4.81 vs 1.19%, p<0.001). On multivariable analysis, PP<50 mmHg stood as an independent predictor of IH-CV mortality after adjustment for age, gender, Pro-BNP, EF, troponin I peak and STEMI (OR 3.84; IC95% 1,57-9.42, p=0.003). Conclusion(s): Although previously associated with a lower cardiovascular risk profile, lower pulse pressure (PP<50 mmHg) at admission is an independent predictor of IH-CV mortality in patients admitted to ACS.