Impact of hypertension on mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty: insights from the international multicenter ISACS-STEMI registry.

Faculty of Medicine

Assiut University

Impact of hypertension on mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty: insights from the international multicenter ISACS-STEMI registry.

Research Authors
Giuseppe De Luca, Matteo Nardin, Magdy Algowhary, Berat Uguz, Dinaldo C Oliveira, Vladimir Ganyukov, et al.
Research Date
Research Department
Department of Cardiology
Research Journal
Journal of Hypertension
Research Member
Magdy Algowhary
Research Publisher
Wolters Kluwer Health
Research Rank
Scopus Q1 (Cardiology), Web of science Q1 (Peripheral Vascular Disease)
Research Vol
NULL
Research Website
NULL
Research Year
2024
Research_Pages
NULL
Research Abstract

Background. Hypertension is the most prevalent cardiovascular risk factor, significantly contributing to cardiovascular mortality and morbidity. Contrasting results have been reported on the prognostic role of hypertension in patients admitted for ST-segment elevation myocardial infarction (STEMI), deserving clarification on its beneficial or detrimental role on short-term outcomes. Therefore, we investigated the impact of hypertension on mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.

Methods. In the ISACS-STEMI COVID-19 registry included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. We collected data on in-hospital outcome and 30-day mortality.

Results. A total of 16083 patients were included in this analysis. Of them, 8813 (54.8%) were hypertensive. They were more often elderly and with a more pronounced cardiovascular risk profile, even if less frequently active smoker. Some procedural differences were appreciated including higher rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor in normotensive patients, while hypertensive subjects more often displayed multivessel disease. With regards of short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among hypertensive patients, similarly in pre-COVID and COVID era. After adjustment for main baseline differences, hypertension was confirmed an independent predictor of both in-hospital death (adjusted OR [95% CI] =1.673 [1.389-2.014], p<0.001) and 30-day mortality (aHR [95% CI] = 1.418 [1.230-1.636], p<0.001). No significant differences were detected in terms of SARS-CoV2 positivity between the two groups.

Conclusion. This is one of the largest and contemporary study reporting the impact of hypertension on patients with STEMI undergoing primary angioplasty, including also the COVID pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-days mortality.