Objectives:We evaluated whether J-curve relation is present between post-discharge blood pressure (BP) and adverse cardiac events in patients with acute myocardial infarction (MI).
Background: In patients with stable coronary artery disease, J-curve relationship has been reported between BP and future cardiovascular events. However, the optimal BP control after management of acute MI has not been established.
Methods:A total of 5,050 patients (63±12 years, male 71%)with acute MI enrolled at 9 medical centers from the Convergent Registry of Catholic and Chonnam National University Hospitals for Acute MI (COREA-AMI) were divided into 6 groups according to mean BP measured within 4 weeks after hospital discharge: group 1 (<110/75 mmHg, n=1,130), group 2 (≥110/75 mmHg, <120/80 mmHg, n=920), group 3 (≥120/80 mmHg,<130/85 mmHg, n=881), group 4 (≥130/85 mmHg,<140/90 mmHg, n=688), group 5 (≥140/90 mmHg,<160/100 mmHg, n=985), and group 6 (≥160/100 mmHg, n=446). Twelve-month clinical outcomes were compared between the groups.
Results:In the study population, 49% had a history of hypertension,55.5% had ST-elevation MI, and 89% underwent percutaneous coronary intervention. Mean systolic and diastolic BP were 95±12 and 57±9 mmHg, 114±3 and 67±6 mmHg, 122±8 and 72±7 mmHg, 132±3 and 75±7 mmHg, 144±7and 83±9mmHg, and 169±15 and 97±13 mmHg in groups 1~6, respectively. Overall clinical outcomes at 12 months were not statistically different between the groups. When the patients were stratified by the GRACE risk score, 12-month rates of death and major adverse cardiac events (MACE: death/MI/repeat revascularization) were similar in the low-risk (risk score≤125) and intermediate-risk (risk score: 126~154) populations. In the high-risk (risk score≥155) population, however, the rates of 12-month death and MACE were both significantly higher ingroup 1 (23.1% and 33.1%), compared to groups 2~6 (12.7% and 21.7%, 17.1% and 26.2%, 13.0% and 22.4%, 15.3% and 22.8%, 16.9% and 23.8%; P=0.028 and P=0.003, respectively).
Conclusions:In patients treated for acute MI, typical J-shaped curve for adverseoutcome was not observed. Lower BP (<110/75 mmHg) was, however, associated with higher mortality and worse clinical outcome in the high-risk population.
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