Impact of Controlled Blood Pressure and Pulse Rate at Discharge on Clinical Outcomes in Patients with Non-ST-segment Elevation Myocardial Infarction.

Objective Angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta-blockers (BBs) are commonly prescribed for patients with non-ST-segment elevation myocardial infarction (NSTEMI). However, the target blood systolic pressure (SBP) or pulse rate (PR) in these patients has not been established. This study aimed to assess the association between SBP/PR control at discharge and the clinical outcomes in patients with NSTEMI. Methods We retrospectively analyzed 596 patients with NSTEMI who received both ACEis/ARBs and BBs at discharge. Patients were categorized into a good control group (SBP ≤130 mmHg and PR ≤80 bpm, n=379) and poor control group (SBP >130 mmHg or PR >80 bpm, n=217). The primary endpoint was major cardiovascular events (MACEs), defined as the composite of all-cause death, non-fatal myocardial infarction, and heart failure readmission. Results During a median follow-up of 1,267 days, 205 MACEs occurred. Kaplan-Meier curves showed higher MACE rates in the poor control group than in the good control group (p=0.003). A multivariate Cox hazard analysis revealed that the good control group was inversely associated with MACEs (hazard ratio 0.748, 95% confidence interval: 0.561-0.997, p=0.048) after controlling for confounding factors. Conclusion Good control of SBP and PR was inversely associated with long-term adverse events in patients with NSTEMI who received both ACEis/ARBs and BBs. This study highlights the significance of optimizing medication titrations at discharge.