Visit-to-Visit Systolic Blood Pressure Variability in Patients with ST-elevation Myocardial Infarction Predicts Long-Term Cardiovascular Outcomes

Abstract

Background: Elevated visit-to-visit blood pressure variability (BPV), independent of mean BP, has been associated with cardiovascular events in a number of diseases. However, its impact after ST-elevation myocardial infarction (STEMI) has not been established. This study aimed to investigate the prognostic impact of BPV on patients after STEMI. Methods: We analyzed the data and clinical outcomes of STEMI survivors who underwent successful primary coronary intervention from 2003 to 2007. To estimate BPV, BP was measured at discharge and at 1, 3, 6, 12, 24, and 36 months-, and we calculated BPV as the intra-individual standard deviations (SDs) of systolic BP (SBP) across these measurements. We classified the patients as high and low-BPV group, and evaluated the following outcomes: occurrence of major adverse cardiovascular events (MACEs), death, recurrent myocardial infarction, and target vessel revascularization within 60 months. Results: We enrolled 343 patients (mean age: 58 ± 12 years: 276 males), and mean follow-up duration was 68 ± 34 months (median: 76 months). Mean and median SBP SDs were 13.2 and 12.3 mmHg, and patients were divided into one of the two groups based on the median (high-BPV = SD ≥12.3 mmHg, and low-BPV group = SD <12.3 mmHg). The MACE-free survival in the high-BPV group was significantly worse than that in low-BPV group (log-rank p =0.035). For the high-BPV group, the risk of a MACE significantly increased by 57% (95% confidence interval: 1.03-2.39: p =0.038). Conclusions: Visit-to-visit systolic BPV was associated with increased rates of adverse clinical outcomes in patients after STEMI. Careful assessment of BP and attempts to reduce BPV might be also important in STEMI survivors.