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He S, Liu W, Wei L, Chen Q, Li Z. A phenomenological model of pulsatile blood pressure-affected degradation of polylactic acid (PLA) vascular stent. Med Biol Eng Comput 2024; 62:1347-1359. [PMID: 38183527 DOI: 10.1007/s11517-023-02998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/09/2023] [Indexed: 01/08/2024]
Abstract
The stent implantation may alter the post-operative patient's blood pressure, and bioresorbable vascular stents (BVS) as a candidate to treat vascular diseases, its degradation is affected by mechanical stress, thus, the altered pressure representing varying stress level will result in different degradation behaviors of the BVS. This paper first proposed a novel stress-regulated PLA degradation model that included swelling factor, and then the degradation evolutions of a PLA BVS within 180 days under normal and high blood pressures were simulated by finite element method, and more four degradation indexes were defined to study the effects of the two blood pressures on the degradation of the PLA BVS. The results showed that the high pressure weakly accelerated the degradation of the PLA BVS with respect to the normal pressure by examining the four indexes, e.g., the residual stent volumev r ( t ) decreased to 0.72 and 0.69, respectively for the normal and high pressures at day 180. The current finding provided a theoretical understanding of the PLA BVS degradation, and hinted that the PLA BVS may not need to be elaborately selected in clinical practices for treating hypertensive patients.
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Affiliation(s)
- Shicheng He
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, People's Republic of China
| | - Wanling Liu
- Jiangsu Key Laboratory of Artificial Functional Materials, College of Engineering and Applied Sciences, Nanjing University, Nanjing, 210023, People's Republic of China
| | - Lingling Wei
- School of Food and Biological Engineering, Hefei University of Technology, Hefei, 230601, People's Republic of China
| | - Qiang Chen
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, People's Republic of China.
| | - Zhiyong Li
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, People's Republic of China.
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD4001, Australia.
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, People's Republic of China.
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2
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Li X, Yu C, Lei L, Liu X, Chen Y, Wang Y, Qiu S, Xiu J. Association of Pre-PCI Blood Pressure and No-Reflow in Patients with Acute ST-Elevation Coronary Infarction. Glob Heart 2024; 19:28. [PMID: 38464557 PMCID: PMC10921965 DOI: 10.5334/gh.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Previous studies have established blood pressure (BP) as a pivotal factor influencing no-reflow following primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute coronary infarction (STEMI). However, no relevant study has been conducted to investigate the optimal range of BP associated with the lowest risk of no-reflow among STEMI patients so far. Therefore, our objective was to evaluate the association between pre-PCI BP and the occurrence of no-reflow in patients with STEMI. Method We included 1025 STEMI patients undergoing primary PCI. The BP pre-PCI was categorized into 20-mmHg increments. Logistic models were employed to assess the association of no-reflow with systolic blood pressure (SBP) or diastolic blood pressure (DBP). Three sensitivity analyses were conducted to further confirm the robustness of the association between blood pressure and no-reflow. Results SBP or DBP exhibited a U-shaped curve association with no-reflow. No-reflow was higher in patients with lower SBP (<100 mmHg) (adjusted hazard ratio (OR) 3.64, 95% confidence interval (CI) 1.84,7.21; p < 0.001) and lower DBP (<60 mmHg) (OR 3.28, 95% CI 1.63,6.49; p < 0.001) [reference: 120 ≤SBP <140; 80 ≤DBP <100 mmHg], respectively. Furthermore, no-reflow was higher in patients with higher SBP (≥160 mmHg) (OR 2.07, 95% CI 1.27,3.36; p = 0.003) and DBP (≥100 mmHg) (OR 3.36, 95% CI 2.07,5.46; p < 0.001), respectively. The results of sensitivity analyses were consistent with the above findings. Conclusion Maintaining a pre-PCI SBP within the range of 120 to 140 mmHg and a DBP within the range of 80 to 100 mmHg may be confer benefits to patients with STEMI in no-reflow.
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Affiliation(s)
- Xiaobo Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, Xiangdong Hospital, Hunan Normal University, Liling, Hunan, China
| | - Chen Yu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Lei
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xuewei Liu
- The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Southern Medical University, Dongguan, Guangdong, China
| | - Yejia Chen
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yutian Wang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - ShiFeng Qiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Manolis AJ, Kallistratos MS, Koutsaki M, Doumas M, Poulimenos LE, Parissis J, Polyzogopoulou E, Pittaras A, Muiesan ML, Mancia G. The diagnostic approach and management of hypertension in the emergency department. Eur J Intern Med 2024; 121:17-24. [PMID: 38087668 DOI: 10.1016/j.ejim.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 03/08/2024]
Abstract
Hypertension urgency and emergency represents a challenging condition in which clinicians should determine the assessment and/or treatment of these patients. Whether the elevation of blood pressure (BP) levels is temporary, in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel. Unfortunately, current guidelines provide few recommendations concerning the diagnostic approach and treatment of emergency department patients presenting with severe hypertension. Target organ damage determines: the timeframe in which BP should be lowered, target BP levels as well as the drug of choice to use. It's important to distinguish hypertensive emergency from hypertensive urgency, usually a benign condition that requires more likely an outpatient visit and treatment.
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Affiliation(s)
- A J Manolis
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece
| | - M S Kallistratos
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece.
| | - M Koutsaki
- Asklepeion General Hospital, Cardiology Department, Vasileos Pavlou 1 street, Voula Greece
| | - M Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - L E Poulimenos
- Asklepeion General Hospital, Cardiology Department, Vasileos Pavlou 1 street, Voula Greece
| | - J Parissis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - E Polyzogopoulou
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - A Pittaras
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia & 2a Medicina ASST Spedali Civili di Brescia, 25121 Brescia, Italy
| | - G Mancia
- University of Milano-Bicocca (Emeritus Professor), Milan, Italy
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Chen B, Wen J, You D, Zhang Y. Implication of cognitive-behavioral stress management on anxiety, depression, and quality of life in acute myocardial infarction patients after percutaneous coronary intervention: a multicenter, randomized, controlled study. Ir J Med Sci 2024; 193:101-109. [PMID: 37351826 PMCID: PMC10808172 DOI: 10.1007/s11845-023-03422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Cognitive-behavioral stress management (CBSM) intervention enhances the psychological status and quality of life in patients with various diseases, such as cancer, human immunodeficiency virus infection, chronic fatigue syndrome, and multiple sclerosis. This multicenter, randomized, controlled study intended to explore the potential benefit of CBSM in ameliorating the anxiety, depression, and quality of life (QoL) in acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). METHODS A total of 250 AMI patients who received PCI were randomly allocated to the CBSM (N = 125) and control care (CC) (N = 125) groups, and underwent weekly corresponding interventions for 12 weeks. The hospital anxiety and depression scale (HADS), EuroQol 5D (EQ-5D), and EuroQol visual analogue scale (EQ-VAS) scores were evaluated at baseline (M0), month (M)1, M3, and M6. Major adverse cardiovascular events (MACE) were recorded during follow-up. RESULTS HADS-anxiety score at M1 (P = 0.036), M3 (P = 0.002), and M6 (P = 0.001), as well as anxiety rate at M6 (P = 0.026), was reduced in the CBSM group versus the CC group. HADS-depression score at M3 (P = 0.027) and M6 (P = 0.002), as well as depression rate at M6 (P = 0.013), was decreased in the CBSM group versus the CC group. EQ-5D score at M3 (P = 0.046) and M6 (P = 0.001) was reduced, while EQ-VAS score at M1 (P = 0.037), M3 (P = 0.010), and M6 (P = 0.003) was raised, in the CBSM group versus the CC group. However, accumulating MACE rate did not differ between the two groups (P = 0.360). CONCLUSION CBSM ameliorates anxiety, depression, and QoL but does not affect MACE in AMI patients after PCI.
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Affiliation(s)
- Biqun Chen
- Intensive Care Unit, Xiamen University, Zhongshan Hospital, Xiamen, 361004, China
| | - Juanling Wen
- Otolaryngology Head and Neck Surgery, Xiamen University, Zhongshan Hospital, Xiamen, 361004, China
| | - Deyi You
- Intensive Care Unit, Xiamen University, Zhongshan Hospital, Xiamen, 361004, China
| | - Yu Zhang
- Department of Nursing, Xiamen Cardiovascular Hospital Xiamen University, No. 2999 Jinshan Road, Xiamen, 361006, China.
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Qiu H, Xin Y, Li W, Wang M, Zhang Y, Chen H, Li H. Association Between Admission Systolic Blood Pressure and Cardiovascular Events in Acute Myocardial Infarction Patients with Different Left Ventricular Ejection Fractions. Anatol J Cardiol 2023; 27:720-729. [PMID: 37882349 DOI: 10.14744/anatoljcardiol.2023.3247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Among patients with acute heart failure, left ventricular ejection fraction (LVEF) is closely related with admission blood pressure. However, it is unclear whether the systolic blood pressure is associated with the LVEF in acute myocardial infarction (AMI) patients. we evaluated the predictive value of admission SBP in AMI patients with different LVEF status. METHODS Data were from our hospital database bank. 4114 patients were included in this analysis. Patients were divided into 2 groups according to their LVEF in the first echocardiography record after admission. Patients were categorized into 4 groups (SBP 90-99 mm Hg, SBP 100-119 mm Hg, SBP 120-139 mm Hg, and SBP ≥140 mm Hg) based on SBP level at admission. RESULTS The mean age was 64.9 ± 12.5 years and 28% were female. For patients of LVEF < 50% in the lowest SBP group (SBP 90-99 mm Hg), the incidence of in-hospital cardiovascular death was significantly higher than other SBP groups (reference: SBP 90-99 mm Hg) (adjusted OR = 0.267, 95% CI: 0.113-0.728 for SBP 120-139 mm Hg, P =.004 and OR = 0.241, 95% CI: 0.089-0.651 for SBP ≥ 140 mm Hg, P =.005). Patients of LVEF ≥50% in the highest SBP group (SBP ≥ 140 mm Hg) were at higher risk of cardiogenic mortality during long-term follow-up (reference: SBP ≥140 mm Hg) (adjusted HR = 0.313, 95% CI: 0.489-0.962 for SBP 100-119 mm Hg, P <.001, HR = 0.701, 95% CI: 0.488-0.987 for SBP 120-139 mm Hg, P =.003, and HR = 0.554, 95% CI: 0.198-0.837 for SBP 90-99 mm Hg, P =.001). CONCLUSION SBP 90-99 mm Hg were associated with increased in-hospital cardiovascular death in AMI population with LVEF < 50%, and SBP > 140 mm Hg were associated with increased long-term cardiovascular death in AMI subjects with LVEF >50%.
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Affiliation(s)
- Hui Qiu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanguo Xin
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Man Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yue Zhang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
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Huang S, Luo Y, Liang L, Guo N, Duan X, Zhou Q, Ge L. The baseline and repeated measurements of DBP to assess in-hospital mortality risk among critically ill patients with acute myocardial infarction: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e30980. [PMID: 36221379 PMCID: PMC9543008 DOI: 10.1097/md.0000000000030980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/06/2022] [Indexed: 01/05/2023] Open
Abstract
Changes in diastolic blood pressure (DBP) are common in patients with acute myocardial infarction (AMI). The relationship between the dynamic change of DBP and in-hospital mortality among patients with AMI remains unclear. This study aimed to explore the importance of DBP during disease development among patients with AMI. We performed a retrospective cohort study involving patients from the Medical Information Mart for Intensive Care III database, which included > 40,000 patients admitted to the intensive care unit (ICU). Overall, 3209 adult AMI admissions were identified. We extracted the clinical and laboratory information in the patients with AMI. Cox proportional hazards models were used to evaluate the prognostic values of baseline DBP. We used the generalized additive mixed model (GAMM) to compare trends in DBP over time among survivors and non-survivors, after adjusting for potential confounders. During the ICU stay, 189 patients died (mortality rate, 6.36%). The age of each non-survivor together with the variations in DBP over time from admission to the time of death is of great importance to the scientific community. Cox multivariable regression analysis displayed that after adjusting for confounding factors, ascended baseline DBP was an important hazard factor for hospital deaths (hazard ratio, 1.02; 95% confidence interval, 1.01-1.03; P = .003). Based on GAMM, DBP in the death group was markedly lower than that of the surviving group. Moreover, the difference between the two groups showed an increasing trend within 3 days after ICU admission. After adjusting for various variables, the results were stable. DBP significantly contributed to in-hospital mortality among patients with AMI. There was a nonlinear correlation between baseline DBP and in-hospital mortality among patients with AMI, and the DBP of the non-survivors decreased within the first 3 days after ICU admission. However, the causality cannot be deduced from our data.
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Affiliation(s)
- Sulan Huang
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Yanlan Luo
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Li Liang
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Ning Guo
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
| | - Xiangjie Duan
- Infectious Disease Department, The First People’s Hospital of Changde, Changde City, Hunan Province, People’s Republic of China
| | - Quan Zhou
- Department of Science and Education Section, The First People’s Hospital of Changde, Changde City, Hunan Province, 415000, People’s Republic of China
| | - Liangqing Ge
- Cardiovascular Medicine Department, The First People’s Hospital of Changde City, Changde City, Hunan Province, People’s Republic of China
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Gan L, Sun D, Cheng Y, Wang D, Wang F, Wang L, Li W, Shen D, Guo D, Zhang Z, Wang H, Li J, Yang Y, Liang T. Post-operative blood pressure and 3-year major adverse cardiac events in Chinese patients undergoing PCI. BMC Cardiovasc Disord 2021; 21:623. [PMID: 34969370 PMCID: PMC8717657 DOI: 10.1186/s12872-021-02435-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no clear evidence for the target value of blood pressure control after Percutaneous coronary intervention (PCI). Therefore, our study was designed to explore the relationship between blood pressure after PCI and major adverse cardiac events (MACE) during 3-year follow-up. METHODS This study is a prospective study. We included the patients who were diagnosed with acute coronary syndrome and underwent PCI stent implantation operation. The study initially collected information of 552 patients. The start and end times of the study are from January 1, 2017 to December 31, 2020. The independent variables of this study are the average systolic blood pressure and the average diastolic blood pressure after PCI. The dependent variable is the occurrence of MACE events in patients within 3 years after PCI. MACE is defined as acute myocardial infarction, recurring chest pain, heart failure, stroke, revascularization and cardiac death. RESULTS A total of 514 subjects met the inclusion criteria. The average age of the study subjects is 61.92 ± 9.49 years old, of which 67.12% are male. 94 subjects had a MACE event within 3 years, and the occurrence rate was 18.29%. There is no significant non-linear or linear relationship between diastolic blood pressure and MACE events. There is a curvilinear relationship between the average systolic blood pressure of patients after PCI and MACE events within 3 years and the inflection point is 121. On the left side of the inflection point, the effect size and 95% CI are 1.09 and 1.01-1.18, respectively (P = 0.029). The impact size and 95% CI at the right inflection point were 1.00 and 0.98-1.02(P = 0.604), respectively. CONCLUSION There is a curvilinear relationship between systolic blood pressure and prognosis of patients after PCI. Under the premise of ensuring the safety of patients, maintaining lower blood pressure after surgery is beneficial to improve the prognosis of patients.
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Affiliation(s)
- Lijun Gan
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dandan Sun
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yuntao Cheng
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Deyang Wang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Fen Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Lin Wang
- Catheterization Room, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Wei Li
- Department of Nursing, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dandan Shen
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Daotong Guo
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Zonglei Zhang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Haiyan Wang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Jinli Li
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yong Yang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Tao Liang
- School of Nursing, Peking Union Medical College, Beijing, China.
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Association of blood pressure in the first-week of hospitalization and long-term mortality in patients with acute left ventricular myocardial infarction. Int J Cardiol 2021; 349:18-26. [PMID: 34838680 DOI: 10.1016/j.ijcard.2021.11.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies have shown that optimal blood pressure (BP) control is necessary to outcomes in patients with acute myocardial infarction (AMI). Acute left ventricular MI is a prevalent type of AMI with poor prognosis. We aimed to analyze the associations between BP control in the first 7 days of hospitalization and long-term mortality specific to patients with isolated left ventricular MI. METHODS A total of 3108 acute left ventricular MI patients were included in this analysis. The average BP on the first seven days of hospitalization was categorized into 10-mmHg increments. The primary and secondary outcomes were all-cause death and cardiac death, respectively. Cox models were used to assess the association of outcomes with BP during hospitalization. RESULTS The median length-of-stay was 7 (IQR 6-10) days. The relationship between systolic BP (SBP) or diastolic BP (DBP) followed a U-shaped curve association with outcomes. All-cause mortality was higher in patients with lower SBP (≤90 mmHg) (adjusted hazard ratios (HRs) 7.12, 95% confidence interval (CI) 3.13-16.19; p < 0.001) and DBP (<60 mmHg) (HR 1.76, 95% CI 1.14-2.71; p = 0.011) [reference: 110 < SBP ≤120 mmHg; 70 < DBP ≤ 80 mmHg], respectively. Furthermore, primary outcome was higher in patients with higher SBP (>130 mmHg) (HR 1.51, 95% CI 1.12-2.03; p = 0.007) and DBP (>80 mmHg) (HR 1.61, 95% CI 1.20-2.18; p = 0.002), respectively. CONCLUSION Maintaining a SBP from 90 to 130 mmHg and a DBP from 60 to 80 mmHg may be beneficial to patients with acute left ventricular MI in the long run.
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Shan R, Ding J, Weng D, Spaulding EM, Wongvibulsin S, Lee MA, Demo R, Marvel FA, Martin SS. Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology. Am J Prev Cardiol 2020; 3:100089. [PMID: 32964212 PMCID: PMC7497394 DOI: 10.1016/j.ajpc.2020.100089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Objective There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI. Methods In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors. Results Sixty-eight AMI patients (mean age 58 ± 10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 mmHg was 59.6% (95% CI: 54.3–64.9%) and <140/90 mmHg was 83.7% (95% CI: 80.3–87.2%). The percentage of systolic BP <90 mmHg was 1.1% (95% CI: 0.17–2.0%) and the percentage of diastolic BP <60 mmHg was 3.9% (95% CI: 2.6–5.2%). Prior CVD was associated with 12.2 mmHg higher mean daily systolic BP during admission (95% CI: 3.5–20.9 mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP. Conclusion The digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health. Digital health reveals home blood pressure trends during early recovery after an event. ~40% of early MI patients had mean daily blood pressure exceeding the guideline goal of <130/80 mmHg. Hypotension occurred rarely over 30 days post-MI. The gap in BP control was especially large in patients in whom MI represented recurrent CVD. There is opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.
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Affiliation(s)
- Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jie Ding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin M. Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S. Martin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
- Corresponding author. Johns Hopkins Hospital, Carnegie 591, 600 North Wolfe Street, Baltimore, MD, 21287, United States.
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Song PS, Lee SH, Jeon KH, Hahn JY, Hur SH, Rha SW, Yoon CH, Jeong MH, Jeong JO, Seong IW, Song YB, Gwon HC. Blood Pressure at 6 Months After Acute Myocardial Infarction and Outcomes at 2 Years: The Perils Associated With Excessively Low Blood Pressures. Can J Cardiol 2020; 36:1641-1648. [PMID: 32413339 DOI: 10.1016/j.cjca.2020.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND This study aimed to determine the association between achieved blood pressure at 6-month follow-up and cardiovascular outcomes at 2 years in patients treated with β-blockers and renin-angiotensin-aldosterone blockers after acute myocardial infarction (AMI). METHODS We analyzed data from 5503 patients enrolled in the national AMI registry. Patients with myocardial reinfarction (MrI), rehospitalization for heart failure (rHHF), or stroke before 6-month follow-up were excluded. Achieved blood pressures were categorized into 10-mm Hg increments. The primary outcome was all-cause death. The secondary outcome was a composite of all-cause death, MrI, and rHHF. Hazard ratios (HRs) were estimated with multivariable-adjusted Cox hazards models using 125- to 134-mm Hg systolic blood pressure (SBP) and 75- to 84-mm Hg diastolic blood pressure (DBP) subgroups as reference. RESULTS After a median follow-up of 2.1 years, SBP < 115 mm Hg was associated with increased risks for all-cause death (adjusted HR: 2.202 [1.158-4.188]) and for a composite outcome (HR: 1.682 [1.075-2.630]). Likewise, DBP < 75 mm Hg tended to be associated with an increase in all-cause death (HR: 2.078 [0.998-4.327] for DBP of 65 to 74 mm Hg; HR: 2.610 [1.256-5.423] for DBP < 65 mm Hg). Even in patients <75 years, the risk of a composite outcome was increased for DBP < 65 mm Hg (HR: 2.492 [1.401-4.434]). CONCLUSIONS Low blood pressure achieved with β-blocker and renin-angiotensin-aldosterone blocker at 6 months was associated with an increased risk of all-cause mortality independently of confounding factors in patients with AMI. This finding suggests that caution should be taken for patients with AMI who use blood-pressure-lowering treatments.
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Affiliation(s)
- Pil Sang Song
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, College of Medicine, Daejeon, Republic of Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Hyun Jeon
- Division of Cardiology, Heart Stroke Vascular Center, Mediplex Sejong General Hospital, Incheon, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Cardiovascular Medicine, Deagu, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, College of Medicine, Daejeon, Republic of Korea
| | - In-Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, College of Medicine, Daejeon, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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The effect of lemon inhalation aromatherapy on blood pressure, electrocardiogram changes, and anxiety in acute myocardial infarction patients: A clinical, multi-centered, assessor-blinded trial design. Complement Ther Clin Pract 2020; 39:101155. [DOI: 10.1016/j.ctcp.2020.101155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022]
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12
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Kim Y, Ahn Y, Cho MC, Kim CJ, Kim YJ, Jeong MH. Current status of acute myocardial infarction in Korea. Korean J Intern Med 2019; 34:1-10. [PMID: 30612415 PMCID: PMC6325441 DOI: 10.3904/kjim.2018.381] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/27/2018] [Indexed: 01/16/2023] Open
Abstract
Coronary artery disease, especially acute myocardial infarction (AMI), is a leading cause of death in the Asia-Pacific region. The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide, prospective, multicenter registry of Korean patients with AMI. Since the KAMIR first began in November 2005, more than 70,000 patients have been enrolled, and 230 papers have been published (as of October 2018). Moreover, published data from the KAMIR have revealed different characteristics from those of Western AMI registries regarding risk factors, interventional strategies, and clinical outcomes. As a result, the KAMIR study has improved the outcomes of percutaneous coronary intervention and reduced mortality. We propose the use of the KAMIR score in the prediction of 1-year mortality. Using data from the KAMIR, we provide an overview of the current status of AMI in Korea, including trends in demographic characteristics, risk factors, medications, treatment strategies, and clinical outcomes.
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Affiliation(s)
- Yongcheol Kim
- Departemt of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Departemt of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myeong Chan Cho
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Chong Jin Kim
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Young Jo Kim
- Department of Cardiology, Yeungnam University Medical Center, Daegu, Korea
| | - Myung Ho Jeong
- Departemt of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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13
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Kimm H, Mok Y, Lee SJ, Lee S, Back JH, Jee SH. The J-curve between Diastolic Blood Pressure and Risk of All-cause and Cardiovascular Death. Korean Circ J 2018; 48:36-47. [PMID: 29322696 PMCID: PMC5764869 DOI: 10.4070/kcj.2017.0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The J-curve phenomenon between diastolic blood pressure (DBP) and mortality has been reported repeatedly in treated patients. However, the baseline risk of low DBP has not been fully explored. This study was to examine the relationship between DBP and risk of mortality from all-cause, atherosclerotic vascular diseases (ASCVD), and ischemic heart disease (IHD) using a prospective cohort of general population. METHODS We analyzed 1,234,435 participants of the Korean Cancer Prevention Study cohort (789,255 men, 30-95 years of age) who had a medical evaluation from 1992 to 1995 using Cox proportional hazards models. RESULTS A total of 22.5 million person-years were followed up (mean age 46.6 years, deaths 193,903 cases). The hazard ratios of mortality from all-cause and ASCVD, among those with DBP <60 mmHg compared to 70-79 mmHg were 1.23 (95% confidence interval [CI], 1.16-1.30) and 1.37 (95% CI, 1.20-1.57), respectively, after adjustment for multivariable including systolic blood pressure. Increased risks of all-cause death in the lowest DBP category group were maintained in men or women, 30-59 or ≥60 years of age, smoker or non-smoker and diabetes mellitus (DM) or non-DM subgroups. The risk in DBP 60-69 mmHg groups increased in several subgroups. However, the risk for ASCVD death in 30-59 years and DM group, and risk for IHD death in most subgroups except for elderly (≥60 years) decreased. CONCLUSION A J-curve relationship between low DBP and all-cause death was found consistently. The baseline risk in the general population may be considered for risk assessment, particularly in case of interventions that lower DBP below 60 mmHg.
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Affiliation(s)
- Heejin Kimm
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yejin Mok
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sun Ju Lee
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Joung Hwan Back
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Lee HY. The J Curve Phenomenon is Still Valid in the Era of Primary Revascularization. Korean Circ J 2017; 47:440-441. [PMID: 28765732 PMCID: PMC5537142 DOI: 10.4070/kcj.2017.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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