PROGNOSTIC SIGNIFICANS OF EARLIER HYPERTENSION, NORMAL AND HIGH ADMISSION SYSTOLIC BLOOD PRESSURE OF PATIENTS WITH MYOCARDIAL INFARCTION WITH AND WITHOUT ST ELEVATION

Abstract

Abstract Objective: To study the effects of earlier hypertension and admission blood pressure on left ventricular ejection fraction (LVEF) and mortality in patients with acute myocardial infarction. Design and method: Retrospective study on 11346 consecutive patients (aged 67,28 + /-11,92years, 7421 (65,4%) male) admitted with ST-elevation myocardial infarction (STEMI) (8268 (72,9%)) and non-ST elevation myocardial infarction (NSTEMI) and normal and high normal (90–139mmHg) or high (> = 140mmHg) systolic blood pressure (SBP) in our tertiary center from january 2013. to october 2019. Intrahospital left ventricular ejection fraction (LVEF) and mortality were recorded. Results: NSTEMI patient compared with STEMI were older (69,68 + /- 11,34 vs. 66,38 + /-12,01; p < 0,001), more frequently had earlier hypertension (2119 (68,8%) vs 5015 (60,7%); p < 0,001), diabetes (843 (27.4%) vs. 1620 (19.6%); p < 0.001), dyslipidemia (909 (29,5,8%) vs 1727 (20,9%); p < 0,001), had higher SBP (140.82 + /-26.03 vs. 139.13 + /-24.23mmHg; p = 0,001), higher proportion of admission hypertensive patients (1665 (54.09%) vs. 3411 (46.48%); p < 0.001), higher LVEF (48.32 + /-11.30% vs. 47.31 + /-9.32%; p < 0.001), and mortality (318 (10.33%) vs. 621 (7.51%) p < 0.001), without diastolic BP difference (82.35 + /-14.02 vs. 82.80 + /-14.14 mmHg; p = 0.131). Only NSTEMI patients with earlier hypertension had higher LVEF (48.61 + /- 9.89% vs. 47.66 + /- 10,81%; p = 0.036) compared with patients without. All hypertensive patients on admission had higher LVEF (NSTEMI 49.05% vs 47.44% and STEMI 48.49% vs 46.30%; p < 0.001), regardless od tipe of MI. NSTEMI patients, compared with STEMI, had higher LVEF, regardless of admission SBP. Only in NSTEMI patients mortality was higher in patients without earlier hypertension (12.2% vs. 9.49%; p = 0.022). Patients with STEMI and normal admission SBP had higher mortality compared with admission hypertensive patient (416 (10,6%) vs. 166 (4,9%); p < 0,001), and even higher if they had prior hypertension. The same was registered in NSTEMI patients with normal SBP (201 (14,2%) vs. 117 (7,0%); p < 0,001), but mortality was even higher without prior hypertension. Conclusions: Patient with NSTEMI more frequently had earlier hypertension, and admission hypertension. NSTEMI patients with normal admission SBP had lower LVEF, only in patients with prior hypertension, and higher mortality particularly in patients without prior hypertension. In STEMI patients mortality was higher in admission normotensive patients, particularly if thay had prior hypertension.