Initial systolic blood pressure associates with systemic inflammation, myocardial injury, and outcomes in patients with acute coronary syndromes
Authors' conclusion
In patients with ACS, proxies of systemic inflammation and myocardial injury are inversely associated with initial sBP levels, with highest biomarker levels observed in those <100 mmHg.
Study context
- Population
- Prospectively recruited acute coronary syndromes (ACS) patients, SBP assessed invasively at admission
- Participants
- 4,724 participants
- Exposure
- ACS patients stratified by initial SBP
- Outcome
- Inflammation and myocardial injury biomarkers by SBP stratum
Main finding
As reported in the abstract
- Leukocyte counts, high-sensitivity C-reactive protein (hs-CRP), high-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase (CK) decreased from low to high SBP strata
- ptrend < 0.001
Observational data: associations, not effects.
Further findings
Major adverse cardiovascular events (MACE), systolic blood pressure (sBP) <100 mmHg · one year
| HR (95% CI) | P value | ||
|---|---|---|---|
| sBP <100 mmHgMultivariable-adjusted; did not persist | 1.38 (0.92–2.05) | P = 0.117 | |
| 0.512Hazard ratio (log scale) |
MACE in patients who developed cardiogenic shock (CS) · 30 days and one year
| HR (95% CI) | P value | ||
|---|---|---|---|
| CS30 days | 3.58 (1.77–7.24) | P < 0.001 | |
| CSOne year | 2.94 (1.57–5.53) | P < 0.001 | |
| 0.10.31310Hazard ratio (log scale) |
- MACE in patients who developed CS: attenuated after controlling for distinct inflammatory profiles
Leukocyte counts, hs-CRP, hs-cTnT and CK across sBP strata
- Decreased from low to high sBP strata
- P for trend < 0.001
Cardiogenic shock (CS)
- sBP <100 mmHg developed CS more often
- P < 0.001
Biomarkers in sBP <100 mmHg with vs without CS
- Higher leukocyte count with CS
- P < 0.001
- Increased neutrophil-to-lymphocyte ratio with CS
- P = 0.031
- Higher hs-cTnT with CS
- P < 0.001
- Higher CK with CS
- P = 0.002
- hs-CRP did not differ
Original publication
Initial systolic blood pressure associates with systemic inflammation, myocardial injury, and outcomes in patients with acute coronary syndromes. Eur Heart J Acute Cardiovasc Care. Published 8 May 2023. doi:10.
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