First 48 hours systolic blood pressure measurement at the acute phase of acute myocardial infarction is associated with one-year cardiovascular mortality among elderly patients

Abstract

Optimal blood pressure (BP) in the elderly patients after acute myocardial infarction (AMI) is still a matter of debate and systolic blood pressure (SBP) target at the acute phase remains to be determined. In a prospective observational study, we aimed to identify optimal SBP during the 48 first hours in AMI and its prognostic value for one-year cardiovascular (CV) mortality. From the RICO survey database, all consecutive patients > 75 years admitted for an AMI in cardiology intensive care unit of the university hospital of Dijon from 01/02/2012 to 31/01/2015 and discharged alive were included ( n = 814). Exclusion criteria were in-hospital death, cardiogenic shock and end-stage renal disease. The endpoints were one-year CV mortality and major adverse cardiac events (MACE). The mean SBP values over the first 48 hours following admission were recorded and analysed. The mSBP cut-off value was determined by ROC curve analysis for the prediction of one-year CV mortality (125 mmHg). Patients were divided into 2 groups according to mSBP [< 125 mmHg ( n = 391) vs ≥ 125 mmHg ( n = 423)]. The median age was 82 years. Patients with mSBP < 125 mmHg had a two-fold risk of one-year CV death compared to mSBP ≥ 125 mmHg patients [47 (12.0%) vs 28 (6.6%), P = 0.008]. By multivariate logistic regression analysis, mSBP < 125 mmHg [OR(95%CI): 1.91(1.07–3.41)] remained a strong predictor of one-year CV mortality, beyond diabetes [OR(95%CI): 2.83(1.47–5.43)], LVEF < 40% [OR(95%CI): 2.44 (1.36–4.36)], BMI < 21 kg/m 2 [OR(95%CI): 2.24(1.11–4.55)] and GRACE risk score [OR(95%CI): 1.04(1.02–1.05)]. In our large population-based study in elderly patients with AMI, low mSBP (< 125 mmHg) in the first 48 hours after admission was an independent and powerful predictor of one-year CV mortality. If confirmed by further cohort studies, early mSBP measurement could help to improve risk stratification. Our results may suggest an optimal blood pressure target in elderly patients.