SPHYGMOMANOMETRICALLY DETERMINED PULSE PRESSURE IS A POWERFUL INDEPENDENT PREDICTOR OF RECURRENT EVENTS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH IMPAIRED LEFT-VENTRICULAR FUNCTION

Citation
Gf. Mitchell et al., SPHYGMOMANOMETRICALLY DETERMINED PULSE PRESSURE IS A POWERFUL INDEPENDENT PREDICTOR OF RECURRENT EVENTS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH IMPAIRED LEFT-VENTRICULAR FUNCTION, Circulation, 96(12), 1997, pp. 4254-4260
Citations number
58
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Peripheal Vascular Diseas",Hematology
Journal title
ISSN journal
0009-7322
Volume
96
Issue
12
Year of publication
1997
Pages
4254 - 4260
Database
ISI
SICI code
0009-7322(1997)96:12<4254:SDPPIA>2.0.ZU;2-S
Abstract
Background There is increasing evidence of a link between conduit vess el stiffness and cardiovascular events, although the association has n ever been tested in a large post-myocardial infarction patient populat ion. Methods and Results We evaluated the relationship between baselin e pulse pressure, measured by sphymomanometry 3 to 16 days after myoca rdial infarction, and subsequent adverse clinical events in the 2231 p atients enrolled in the SAVE Trial. Increased pulse pressure was assoc iated with increased age, left ventricular ejection fraction, female s ex, history of prior infarction, diabetes, and hypertension and use of digoxin and calcium channel blockers. Over a 42-month period, there w ere 503 deaths, 422 cardiovascular deaths, and 303 myocardial infarcti ons. Pulse pressure was significantly related to each of these end poi nts as a univariate predictor. In a multivariate analysis, pulse press ure remained a significant predictor of total mortality (relative risk , 1.08 per 10 mmHg increment in pulse pressure. 95% CI, 1.00 to 1.17; P<.05) and recurrent myocardial infarction (relative risk, 1.12; 95% C I, 1.01 to 1.23; P<.05) after control for age; left ventricular ejecti on fraction; mean arterial pressure; sex; treatment arm (captopril or placebo); smoking history; history of prior myocardial infarction, dia betes, or hypertension; and treatment with beta-blockers, calcium chan nel blockers, digoxin, aspirin. or thrombolytic therapy. Conclusions T hese data provide strong evidence for a link between pulse pressure, w hich is related to conduit vessel stiffness, and subsequent cardiovasc ular events after myocardial infarction in patients with left ventricu lar dysfunction.