Central arterial pressure predicts in-hospital major adverse cardiovascular events after acute ST-segment elevation myocardial infarction: a retrospective cohort study

BACKGROUND: Percutaneous coronary intervention (PCI) is currently the main treatment of acute ST-segment elevated myocardial infarction (STEMI), whereafter various postoperative adverse events often occur. Central arterial pressure (CAP) is closely related to the pathophysiological process of cardiovascular disease, and its relationship with outcomes after PCI in STEMI patients remains unclear. The aim of this study was to observe the relationship between pre-PCI CAP and in-hospital outcomes in STEMI patients which might be helpful to evaluate prognosis. METHODS: A total of 512 STEMI patients who underwent emergency PCI were included. Baseline data and CAP information before PCI and in-hospital outcomes were collected. Multivariate logistic regression was used to adjust for confounding factors. Potential non-linear relationships between CAP and in-hospital outcomes were described using a restricted cubic bar plot. The area under the receiver operating characteristic (ROC) curve (AUC), net reclassification index, and composite discriminant improvement index were used to analyze the correlation between CAP and outcomes during hospitalization. RESULTS: Among the 512 patients, 116 experienced at least 1 in-hospital major adverse cardiovascular events (MACEs), with an incidence rate of 22.60%. Among CAP indicators, higher [>137.5 mmHg, OR =2.70, 95% confidence interval (CI): 1.20–6.06] or lower (<102 mmHg, OR =7.55, 95% CI: 3.45–16.52) central systolic pressure (CSP), lower (<61 mmHg, OR =2.78, 95% CI: 1.36–5.67) central diastolic pressure (CDP), higher (>55 mmHg, OR =2.09, 95% CI: 1.01–4.31) or lower (<29 mmHg, OR =3.28, 95% CI: 1.54–7.00) central pulse pressure (CPP), and higher (>101 mmHg, OR =2.07, 95% CI: 1.01–4.61) or lower (<76 mmHg, OR =4.91, 95% CI: 2.31–10.44) central mean pressure (CMP) were independent risk factors for MACEs. The relationship between CSP and CMP and in-hospital outcomes showed a “J”-shaped relationship, CDP and in-hospital outcomes showed an “L”-shaped relationship, and CPP and in-hospital outcomes showed a “U”-shaped relationship. There was no statistical difference in the prediction ability of in-hospital outcomes detected between CSP, CDP, and CMP (P>0.05), but the comparison of the 3 with CPP was statistically significant (P<0.05). CONCLUSIONS: CSP, CDP, and CMP have certain predictive ability for postoperative in-hospital outcomes in STEMI patients and can be used during percutaneous intervention.