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

Fecha de publicación: 14/10/2024 Fecha Ahead of Print: 14/10/2024

Autores de IIS La Fe

José Luis Díez Gil

Autor

Participantes ajenos a IIS La Fe

De Luca G
Nardin M
Algowhary M
Uguz B
Oliveira DC
Ganyukov V
Zimbakov Z
Cercek M
Okkels Jensen L
Loh PH
Calmac L
Roura I Ferrer G
Quadros A
Milewski M
Scotto D'Uccio F
von Birgelen C
Versaci F
Ten Berg J
Casella G
Lung AWS
Kala P
Carrillo X
Dirksen M
Becerra-Munoz VM
Lee MK
Juzar DA
de Moura Joaquim R
Paladino R
Milicic D
Davlouros P
Bakraceski N
Zilio F
Donazzan L
Kraaijeveld A
Galasso G
Lux A
Marinucci L
Guiducci V
Menichelli M
Scoccia A
Yamac AH
Mert KU
Flores Rios X
Kovarnik T
Kidawa M
Moreu J
Flavien V
Fabris E
Lozano Martínez-Luengas I
Boccalatte M
Bosa Ojeda F
Arellano-Serrano C
Caiazzo G
Cirrincione G
Kao HL
Sanchis Forés J
Vignali L
Pereira H
Manzo S
Ordoñez S
Arat Özkan A
Scheller B
Lehtola H
Teles R
Mantis C
Antti Y
Brum Silveira JA
Zoni R
Bessonov I
Savonitto S
Kochiadakis G
Alexopulos D
Uribe CE
Kanakakis J
Faurie B
Gabrielli G
Gutierrez Barrios A
Bachini JP
Rocha A
Tam FC
Rodriguez A
Lukito AA
Saint-Joy V
Pessah G
Parodi G
Burgadha MA
Kedhi E
Lamelas P
Suryapranata H
Verdoia M

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

Abstract

BACKGROUND: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic. METHODS: The ISACS-STEMI COVID-19 was a retrospective registry that included STEMI patients treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 in 109 high-volume primary PCI centers from 4 continents. We collected data on baseline, clinical and procedural characteristics, in-hospital outcome and 30-day mortality. For this analysis patients were grouped according to history of hypertension at admission. RESULTS: A total of 16083 patients were assessed, including 8813 (54.8%) with history of hypertension. These patients were more often elderly, with a worse cardiovascular risk profile, but were less frequently active smoker. Some procedural differences were observed between the two groups, including lower rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor but more extensive coronary disease in patients with hypertension. Between patients with and without hypertension, there was no significant difference in SARS-CoV-2 positivity. Hypertensive patients had a significantly higher in-hospital and 30-day mortality, similarly observed in both pre-COVID-19 and COVID-19 era, and confirmed after adjustment for main baseline differences and propensity score (in-hospital mortality: adjusted odds ratio (OR) [95% confidence interval (CI)] =1.673 [1.389-2.014], P < 0.001; 30-day mortality: adjusted hazard ratio (HR) [95% CI] = 1.418 [1.230-1.636], P < 0.001). CONCLUSION: This is one of the largest and contemporary study assessing the impact of hypertension in STEMI patients undergoing primary angioplasty, including also the COVID-19 pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-day mortality.