Prognostic impact of systolic blood pressure at admission on in-hospital outcome after primary percutaneous coronary intervention for acute myocardial infarction

SummaryBackgroundData regarding the relationship between systolic blood pressure (SBP) at admission and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still lacking in Japan.Methods and resultsA total of 1475 primary PCI-treated AMI patients were classified into quintiles based on admission SBP (<105 mmHg, n = 300; 105–125 mmHg, n = 294; 126–140 mmHg, n = 306; 141–158 mmHg, n = 286; and ≥159 mmHg n = 289). The patients with SBP < 105 mmHg tended to have higher age, previous myocardial infarction, chronic kidney disease (CKD), Killip class ≥ 3 at admission, right coronary artery, left main trunk (LMT), or multivessels as culprit lesions, larger number of diseased vessels, lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery before primary PCI, and higher value of peak creatine phosphokinase concentration. Patients with SBP < 105 mmHg had a significantly higher mortality, while mortality was not significantly different among the other quintiles: 24.3% (<105 mmHg), 4.8% (105–125 mmHg), 4.9% (126–140 mmHg), 2.8% (141–158 mmHg), and 5.2% (≥159 mmHg) (p < 0.001). On multivariate analysis, Killip class ≥ 3 at admission, LMT or multivessels as culprit lesions, admission SBP < 105 mmHg, CKD, and age were the independent positive predictors of in-hospital mortality, whereas admission SBP 141–158 mmHg and TIMI 3 flow after PCI were the negative ones, but admission SBP 105–125 mmHg, admission SBP 126–140 mmHg, and admission SBP ≥ 159 mmHg were not.ConclusionsThese results suggest that admission SBP 141–158 mmHg might be correlated with better in-hospital prognosis, whereas admission SBP < 105 mmHg was associated with in-hospital death in Japanese AMI patients undergoing primary PCI.