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Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation

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Abstract

We sought to investigate the effect of ward-to-cath lab blood pressure (BP) differences on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). There are limited data available on the association between PCI with DES and BP differences on long-term clinical outcomes. This study enrolled 994 patients who underwent PCI with DES from March 2003 to August 2007. Resting BP was measured in a ward environment before transfer to the cardiac catheterization lab (cath lab), and again when the patient was laid down on the cath lab table. Patients were divided into two groups according to the difference in ward-to-cath lab systolic BP. Large difference group (n = 383) was defined as the absolute systolic difference of >20 mmHg and small difference group (n = 424) as the absolute systolic difference of ≤20 mmHg. The primary endpoints were all-cause mortality, cardiac death, nonfatal myocardial infarction and stroke. A total of 807 patients (mean age 60 ± 10 years, 522 males) received follow-up for 5.1 ± 2.4 years. The rate of all-cause mortality was significantly higher in the large difference group compared to the small difference group (6.6 vs. 2.8 %; adjusted hazard ratio (HR) 2.43; 95 % confidence interval (CI) 1.22–4.83; p = 0.012). There were higher cardiac deaths seen in the large difference group compared to the small difference group (3.9 vs. 1.4 %; adjusted HR 2.84; 95 % CI 1.1–7.31; p = 0.031). Stroke (2.4 vs. 1.2 %, p = 0.125) and TVR (3.7 vs. 1.7 %, p = 0.051) had higher trends in the large difference group compared to the small difference group. The composite of primary endpoints (all-cause mortality, cardiac death, nonfatal MI and stroke) occurred more frequently in the large difference group compared to the small difference group (10.0 vs. 6.4 %; adjusted HR 1.71; 95 % CI 1.04–2.81; p = 0.033). A difference in ward-to-cath lab systolic BP of >20 mmHg may contribute to increased adverse outcomes in the form of all-cause mortality and cardiac deaths in patients undergoing PCI with DES.

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Acknowledgments

This study was supported by 2013 Research Grant from Kangwon National University.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, South Korea

    Ae-Young Her & Yong Hoon Kim

  2. Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea

    Soe Hee Ann, Jun Ho Lee, Jong Min Kim, Gillian Balbir Singh & Eun-Seok Shin

  3. East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK

    Scot Garg

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  1. Ae-Young Her
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  2. Soe Hee Ann
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  3. Jun Ho Lee
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  4. Jong Min Kim
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  5. Yong Hoon Kim
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Correspondence to Eun-Seok Shin.

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Her, AY., Ann, S.H., Lee, J.H. et al. Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation. Heart Vessels 30, 740–745 (2015). https://doi.org/10.1007/s00380-014-0550-3

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  • DOI: https://doi.org/10.1007/s00380-014-0550-3

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