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A low pulse pressure predicts mortality in subjects with heart failure after an acute myocardial infarction: a post-hoc analysis of the CAPRICORN study

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Abstract

Background

In patients with cardiovascular disease, a high pulse pressure is related to an increased risk of cardiovascular events but in patients with advanced heart failure, a low pulse pressure is predictive of adverse (cardiovascular) events.

Aim

We studied the prognostic importance of pulse pressure in a group of post-myocardial infarction patients, with and without signs and symptoms of heart failure. Subjects had been randomised in the CAPRICORN clinical trial, and followed up for a mean of 1.3 years.

Methods

Blood pressure was measured in 1,955 patients with a left ventricular ejection fraction ≤40%, between 3 and 21 days post myocardial infarction. Cox proportional survival models were reproduced for those with Killip Class I (n = 1342) versus classes II/III/IV heart failure (n = 613).

Results

Overall mean (SD) age was 63 (12) years, mean (SD) left ventricular ejection fraction 33(6)%, mean (SD) baseline blood pressure was 121 (17)/74 (10) mmHg and most (73%) were male. In patients with Killip Class 1, pulse pressure was not predictive for any outcome. However, in patients with Killip Class II–IV, a low pulse pressure independently predicted all cause mortality (HR 0.83 per 10 mmHg, CI 0.71–0.98, p = 0.025), cardiovascular mortality (HR 0.83 per 10 mmHg, CI 0.70–0.98, p = 0.025) and sudden death (HR 0.77 per 10 mmHg, CI 0.60–1.00, p = 0.047). A lower pulse pressure did not predict hospitalisation for worsening heart failure.

Conclusion

A low pulse pressure is an independent predictor of mortality in subjects with depressed left ventricular ejection fraction after a recent myocardial infarction and evidence of Killip Class II–IV heart failure.

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Authors and Affiliations

  1. Clinical Research Initiative, Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, Scotland, UK

    Colin J. Petrie & Henry J. Dargie

  2. Department of Cardiology, Thoraxcenter, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands

    Adriaan A. Voors & Dirk J. van Veldhuisen

  3. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, G11 6NT, Scotland, UK

    Michele Robertson

Authors
  1. Colin J. Petrie
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  2. Adriaan A. Voors
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  3. Michele Robertson
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  4. Dirk J. van Veldhuisen
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  5. Henry J. Dargie
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Correspondence to Colin J. Petrie.

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Petrie, C.J., Voors, A.A., Robertson, M. et al. A low pulse pressure predicts mortality in subjects with heart failure after an acute myocardial infarction: a post-hoc analysis of the CAPRICORN study. Clin Res Cardiol 101, 29–35 (2012). https://doi.org/10.1007/s00392-011-0360-x

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  • DOI: https://doi.org/10.1007/s00392-011-0360-x

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