Short-term Prognostic Importance Of Ambulatory Pulse Pressure and Other Bood Pressure Parameteres In Patients With Acute ST Elevation Myocardial Infarction

Öz

Purpose: It is known that high blood pressure increased cardiovascular mortality and affected the prognosis in patients with acute myocardial infarction (AMI). However the blood pressure parameter which is more important and the ideal level of blood pressure have not been known yet.In this study we aimed to investigate affect of early phase ambulatory pulse pressure and other blood pressure levels one month cardiovascular end points. Materials and Methods:119 patients with first ST elevation AMI included in this study. Ambulatory blood pressures were measured in first 48 hour after admission. Left ventricular ejection fraction and wall motion score index (WMSI) were measured by echocardiography within 72 hour of admission. One month later cardiovascular end points were recorded by phone call. Results: One month mortality, reinfarction and recurrent angina rate were found as 6%, 3% and 16%, respectively. Advanced age, increased WMSI and lack of use of beta blockers were related with cardiovascular end points ( p <0.005, p<0.05, p<0.05, respectively). The relationship between blood pressure indexes and 1 month cardiac end points could not be found. This relationship also could not be found after adjustment with age, WMSI and beta blocker use in multivariate analysis. In patients with recurrent angina; mean diastolic blood pressure was found as 66±7 mmHg and those without recurrent angina it was 71±8 mmHg ( p<0.05) . Relative risk for recurrent angina in patients with diastolic blood pressure less than 70 mmHg was found as 2,4 ( 95% CI: 0.92-4.23). Conclusion: In this study ambulatory blood pressure parameters were not significantly different between patients with or without cardiovascular events. But low diastolic blood pressure levels were related with recurrent angina.

Anahtar Kelimeler

• acute myocardial infarction,blood pressure,pulse pressure,cardiovascular mortality

ST-Elevasyonlu Akut Miyokard İnfarktüslü Hastalarda Ambulatuar Nabız Basıncı ve Diğer Kan Basıncı Parametrelerinin Erken Dönem Prognostik Önemi

Öz

Amaç: Yüksek kan basıncının kardiyovasküler mortaliteyi artırdığı ve akut miyokard infarktüslü (AMI) olgularda prognozu etkilediği bilinmektedir. Ancak hangi kan basıncı parametresinin ne kadar önemli olduğu ve infarktüslü olgularda ideal kan basıncı düzeyinin ne olduğu iyi bilinmemektedir. Çalışmamızda AMI’lı olgularda erken dönem ambulatuar nabız basıncı ve diğer kan basıncı düzeylerinin bir aylık kardiyovasküler son noktalar üzerine etkisinin olup olmadığını araştırmayı amaçladık. Materyal ve metod: Çalışmamıza ilk kez ST segment elevasyonlu AMI geçiren toplam 119 hasta alındı. Hastalara yatışlarının ilk 48 saati içinde kan basıncı ölçümü için ambulatuar tansiyon aleti takıldı. Tüm hastalara yatışlarının ilk 72 saati içinde ekokardiyografi yapılarak ejeksiyon fraksiyonu ve duvar hareket skor indeksi (WMSI) hesaplandı. Hastalar 1 ay sonra telefon ile aranarak kardiyovasküler son noktalar( ölüm, reenfarkt, rekürren anjina) kaydedildi. Bulgular: Hastaların 1 aylık mortalite oranı %6, reinfarktüs oranı %3 ve rekürren anjina oranı %16 olarak bulundu. İleri yaş, artmış WMSI ve beta-bloker kullanmamak majör kardiyak son noktalar ile ilişkili bulunmuştur (sırasıyla p<0,005, p<0,05, p<0,05). Kan basıncı indeksleri ile 1 aylık kardiyak son noktalar arasında ilişki bulunamamıştır. Bu ilişki multivariate analizinde yaş, WMSI ve beta-bloker kullanımına göre düzeltildikten sonra bile izlenmemiştir. Ancak rekürren anjina gelişenlerde ortalama diastolik kan basıncı (DKB) 66 ±7 mmHg, gelişmeyenlerde 71±8 mmHg olarak bulunmuştur (p<0,05). DKB’ nin 70 mmHg altında olması ile rekürren anjina için rölatif risk 2,4 (%95 CI: 0,92-4,23) olarak bulunmuştur. Sonuç: Çalışmamızda ambulatuar kan basıncı parametreleri kardiyovasküler olay gelişen ve gelişmeyen hastalarda farklı olmamakla birlikte düşük diyastolik kan basınçları rekürren anjina ile ile ilişkili bulunmuştur.

Anahtar Kelimeler

• Akut myokard enfarktüsü,kan basıncı,nabız basıncı,kardiyovasküler mortalite

Kaynakça

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