Evaluation of systolic, diastolic, and pulse pressure as risk factors for severe coronary arteriosclerotic disease in women with unstable angina non-ST-elevation acute myocardial infarction.

Abstract

To evaluate pressures assessed at the aortic root as risk factors for severe atherosclerotic coronary heart disease in women with unstable angina/compatible clinical history associated with increase in cardiac enzymes (total CPK and CK-MB) 2 times greater than the standard value used in the hospital, with the absence of new Q waves on the electrocardiogram (UA/NSTEMI). Five hundred and ninety-three female patients with clinical diagnosis of UA/NSTEMI underwent cinecoronariography from March 1993 to August 2001, and the risk factors for CHD were studied. During examination the pressures, at the aortic root, and coronary obstructions were visually assessed by 2 interventional cardiologists, and those stenosis over 70% were considered severe. Eight-one per cent of the population was white and 18.3% was black. Mean age was 59.2+/-11.2 years, and it was significantly higher in patients with severe coronary lesions: 61.9 +/- 10.8 years versus 56.4 +/- 10.8 years; smoking, diabetes mellitus and climacteric were more frequent in patients with CHD. The average mean arterial pressure and mean systolic blood pressure was the same in both groups, however, average left ventricle diastolic pressure (17.6 +/- 8.7 x 15.1 +/- 8.1, p=0.001), and aortic pulse pressure were significantly greater in patients with CHD (75.5 +/- 22 x 70 +/- 19, p=0.002), while average aortic diastolic pressure was significantly greater in patients without CHD (79.8 +/- 16 x 75.3 +/- 17.5, p=0.003). In the multivariated analysis, pulse pressure > 80 mmHg and systolic blood pressure > 165 were independently associated with severe CHD with odds ratio of 2.12 and 2.09, p<0.05, respectively. CHD is associated with increased pulse pressure and lower diastolic blood pressure in women with UA/NSTEMI. Although average systolic blood pressure has not been associated with CHD in this population, dichotomized values of pulse pressure > 80 mmHg and systolic blood pressure > 165 mmHG determined risk two times greater of severe coronary disease.