Association between admission systolic blood pressure and cardiovascular events in acute myocardial infarction patients with different left ventricular ejection fractions

Abstract

Abstract Background It has been reported that 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. Therefore, we evaluated the predictive value of admission SBP in AMI patients with different LVEF status. Methods Patients’ clinical data were extracted from the Cardiovascular Center of Beijing Friendship Hospital Database Bank (CBD BANK). A total of 4114 patients were included in this analysis. The included patients were divided into two groups according to their left ventricular ejection fraction (LVEF) in the first echocardiography record after admission. Patients were categorized into four groups (SBP 90- 99mmHg, SBP 100-119mmHg, SBP 120-139mmHg, SBP ≥ 140mmHg) 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 90-99mmHg), the incidence of in-hospital cardiovascular death was significantly higher than other SBP groups (reference: SBP 90–99 mmHg) [adjusted odds ratio (OR) 0.287, 95% confidence interval (CI) 0.110–0.748 for SBP 120–139 mmHg, and OR 0.241, 95% CI 0.089–0.651 for SBP ≥ 140 mmHg]. The patients of LVEF ≥ 50% in the highest SBP group (SBP ≥ 140mmHg) were at significantly higher risk of cardiogenic mortality during long-term follow-up (reference: SBP ≥ 140 mmHg) [adjusted hazard ratio (HR) 0.753, 95% CI: 0.530–0.871 for SBP 100–119 mmHg, HR 0.765, 95% CI: 0.567–0.933 for SBP 120–139 mmHg, and HR 0.519, 95% CI: 0.236–0.840 for SBP 90–99 mmHg]. Conclusion SBP 90-99mmHg were associated with increased in-hospital cardiovascular death in AMI population with LVEF < 50%, and SBP > 140mmHg were associated with increased long-term cardiovascular death in AMI subjects with LVEF > 50%.