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Prognostic power of lower pulse pressure on long-term all-cause mortality in octogenarians with acute coronary syndrome: a propensity-score-matched cohort study

Li, Shijuna,b; Barywani, Salima; Fu, Michaela

doi: 10.1097/HJH.0000000000000403
ORIGINAL PAPERS: Epidemiology

Objective: The impact of lower pulse pressure (PP) on long-term all-cause mortality in the octogenarian patients with acute coronary syndrome (ACS) remains unknown. This study sought to reveal the prognostic power of lower PP in long-term all-cause mortality in the octogenarian ACS patients.

Methods: The current study included a total of 353 consecutive ACS patients aged at least 80 years during the period of 5-year follow-up. Association between PP and long-term mortality was confirmed by sensitivity analyses such as propensity score matching and multivariate Cox analyses. The matched cohort was developed by one-to-one, nearest-neighbor propensity score matching analyses.

Results: Among patients with ACS, 113 (32.1%) admissions were alive, 240 (67.9%) were dead. There was a U-shaped association of mortality rate with PP, and the mortality rate increased in patients with PP equal to or less than 50 mmHg and greater than 70 mmHg. PP equal to or less than 50 mmHg was a predictor of the mortality rate in the overall cohort [hazard ratio: 1.92, 95% confidence interval (CI): 1.08–3.43, P = 0.027] and in the matched cohort (hazard ratio: 2.67, 95% CI: 1.16–6.14, P = 0.020). Moreover, PP equal to or less than 50 mmHg was independently related to mortality rate in the subgroup with hypertension in the overall cohort (hazard ratio: 2.04, 95% CI: 1.04–4.00, P = 0.039) and in the matched cohort (hazard ratio: 2.63, 95% CI: 1.01–6.83, P = 0.048).

Conclusion: This study reveals a U-shaped association of mortality rate with PP in the octogenarians with ACS and demonstrates that PP equal to or less than 50 mmHg has an independent prognostic power in long-term all-cause mortality in the octogenarians with ACS as well as the subgroup with hypertension.

aSection of Cardiology, Department of Medicine, Sahlgrenska University Hospital, Östra Hospital, Gothenburg, Sweden

bSection of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China

Correspondence to Shijun Li, Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital, Östra Hospital, Gothenburg, Sweden. Tel: +46 31 3434071 (office); fax: +4631 259254; e-mail: lishijun817@126.com

Abbreviations: ACEIs, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARBs, angiotensin II receptor blockers; BP, blood pressure; CCB, calcium channel blocker; CI, confidence interval; CK-MB, creatine kinase-MB; NSTEMI, non-ST elevation myocardial infarction; PCI, percutaneous coronary intervention; PP, pulse pressure; STEMI, ST elevation myocardial infarction

Received 9 June, 2014

Revised 26 August, 2014

Accepted 27 August, 2014

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