31 ADMISSION OF SYSTOLIC BLOOD PRESSURE AND ANTECEDENT HYPERTENSION WORSENING THE SHORT-TERM OUTCOMES AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

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Background and Aim: The prevalence of antecedent hypertension varies from 46.0% to 63.4%. Until recently, many studies evaluated the prognostic significance of a previous history of hypertension in patients presented with ST-segment elevation myocardial infarction (STEMI) and came to inconsistent result. We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with STEMI. Materials and Methods: Data were derived from Malang ACS registry of 534 consecutive patients with STEMI. STEMI within 12 hours after the onset of symptoms 2018 and 2020. The diagnosis of STEMI was followed the universal definition of myocardial infarction. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 30-day all-cause mortality. Results: The prevalence of hypertension was 38.6%, and the best cutoff of admission SBP for predicting 30-day mortality was 94 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often male, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (±94 mmHg) and hypertension group had significantly higher 30-day mortality than those in other groups (all P < 0.000). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 30-day mortality (hazard ratios [HR] 1.66, 95% confidence interval [CI] 1.21—2.16; P < 0.001). In patients with SBP > 94 mmHg, a history of hypertension could increase the risk of 30-day mortality by 17% (HR 1.06 vs 1.37, P = 0.004), while in patients with SBP ± 94 mmHg, this increased risk reached to 44% (HR 1.21 vs 2.38, P < 0.001). Conclusion: Low admission SBP was the relatively dominant contributor for predicting 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality