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Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction

Objective: Although the clinical outcomes for patients with ST-elevation myocardial infarction (STEMI) have improved significantly, some patients still experience poor clinical outcomes. The available risk classifications focus on the short-term outcomes, and it remains important to find high-risk f...

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Autores principales: Yamashita, Takahiro, Sakakura, Kenichi, Jinnouchi, Hiroyuki, Taniguchi, Yousuke, Tsukui, Takunori, Hatori, Masashi, Tamanaha, Yusuke, Kasahara, Taku, Watanabe, Yusuke, Yamamoto, Kei, Seguchi, Masaru, Fujita, Hideo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647226/
https://www.ncbi.nlm.nih.gov/pubmed/37959393
http://dx.doi.org/10.3390/jcm12216928
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author Yamashita, Takahiro
Sakakura, Kenichi
Jinnouchi, Hiroyuki
Taniguchi, Yousuke
Tsukui, Takunori
Hatori, Masashi
Tamanaha, Yusuke
Kasahara, Taku
Watanabe, Yusuke
Yamamoto, Kei
Seguchi, Masaru
Fujita, Hideo
author_facet Yamashita, Takahiro
Sakakura, Kenichi
Jinnouchi, Hiroyuki
Taniguchi, Yousuke
Tsukui, Takunori
Hatori, Masashi
Tamanaha, Yusuke
Kasahara, Taku
Watanabe, Yusuke
Yamamoto, Kei
Seguchi, Masaru
Fujita, Hideo
author_sort Yamashita, Takahiro
collection PubMed
description Objective: Although the clinical outcomes for patients with ST-elevation myocardial infarction (STEMI) have improved significantly, some patients still experience poor clinical outcomes. The available risk classifications focus on the short-term outcomes, and it remains important to find high-risk features among patients with STEMI. In Japan, the 200 m walk electrocardiogram (ECG) test is widely performed before discharge. The purpose of this study was to investigate the association between the excessive increase in systolic blood pressure (SBP) following a 200 m walk and the long-term clinical outcomes in patients with STEMI. Methods: We included 680 patients with STEMI and divided those into an excessive increase in SBP group (n = 144) and a non-excessive increase in SBP group (n = 536) according to the SBP increase after a 200 m walk ECG test. We defined an excessive increase in SBP as SBP ≥ 20 mmHg either just after or 3 min after a 200 m walk ECG test. The primary endpoint consisted of major cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization. Results: The median follow-up duration was 831 days. MACE was more frequently observed in the excessive increase in SBP group (24.3%) than in the non-excessive increase in SBP group (15.1%). Multivariate Cox hazard analysis revealed that the excessive increase in SBP was significantly associated with MACE (HR 1.509, 95% CI: 1.005–2.267, p = 0.047) after controlling for multiple confounding factors. Conclusion: An excessive increase in SBP after the 200 m walk ECG test was significantly associated with MACE in patients with STEMI. The 200 m walk ECG test is simple and low-cost, but may help to identify high-risk patients with STEMI.
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spelling pubmed-106472262023-11-04 Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Yamashita, Takahiro Sakakura, Kenichi Jinnouchi, Hiroyuki Taniguchi, Yousuke Tsukui, Takunori Hatori, Masashi Tamanaha, Yusuke Kasahara, Taku Watanabe, Yusuke Yamamoto, Kei Seguchi, Masaru Fujita, Hideo J Clin Med Article Objective: Although the clinical outcomes for patients with ST-elevation myocardial infarction (STEMI) have improved significantly, some patients still experience poor clinical outcomes. The available risk classifications focus on the short-term outcomes, and it remains important to find high-risk features among patients with STEMI. In Japan, the 200 m walk electrocardiogram (ECG) test is widely performed before discharge. The purpose of this study was to investigate the association between the excessive increase in systolic blood pressure (SBP) following a 200 m walk and the long-term clinical outcomes in patients with STEMI. Methods: We included 680 patients with STEMI and divided those into an excessive increase in SBP group (n = 144) and a non-excessive increase in SBP group (n = 536) according to the SBP increase after a 200 m walk ECG test. We defined an excessive increase in SBP as SBP ≥ 20 mmHg either just after or 3 min after a 200 m walk ECG test. The primary endpoint consisted of major cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization. Results: The median follow-up duration was 831 days. MACE was more frequently observed in the excessive increase in SBP group (24.3%) than in the non-excessive increase in SBP group (15.1%). Multivariate Cox hazard analysis revealed that the excessive increase in SBP was significantly associated with MACE (HR 1.509, 95% CI: 1.005–2.267, p = 0.047) after controlling for multiple confounding factors. Conclusion: An excessive increase in SBP after the 200 m walk ECG test was significantly associated with MACE in patients with STEMI. The 200 m walk ECG test is simple and low-cost, but may help to identify high-risk patients with STEMI. MDPI 2023-11-04 /pmc/articles/PMC10647226/ /pubmed/37959393 http://dx.doi.org/10.3390/jcm12216928 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Yamashita, Takahiro
Sakakura, Kenichi
Jinnouchi, Hiroyuki
Taniguchi, Yousuke
Tsukui, Takunori
Hatori, Masashi
Tamanaha, Yusuke
Kasahara, Taku
Watanabe, Yusuke
Yamamoto, Kei
Seguchi, Masaru
Fujita, Hideo
Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction
title Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction
title_full Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction
title_fullStr Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction
title_full_unstemmed Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction
title_short Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction
title_sort impact of excessive increase in systolic blood pressure after exercise on clinical outcomes in patients with st-segment elevation myocardial infarction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647226/
https://www.ncbi.nlm.nih.gov/pubmed/37959393
http://dx.doi.org/10.3390/jcm12216928
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