International journal of cardiology · 2026
Joint effects of pulse pressure and LVEF on 12-month mortality in acute coronary syndrome patients undergoing PCI.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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De Yanshan, Han Yu, Song Yuanyuan, Zhang Xiuheng, Wu Shuo, Wang Bailu, Wei Shujian, Chen Yuguo
Аннотация
AIM: To evaluate admission pulse pressure (PP) as an independent predictor of 12-month mortality in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), and to explore its joint effect with left ventricular ejection fraction (LVEF).
METHODS: This observational study analyzed 2213 consecutive ACS patients from the BIPass study who underwent PCI. Patients were stratified by LVEF (>50% vs. ≤50%) and PP levels (≤ 40 mmHg, 40 < PP ≤ 60 mmHg, 60 < PP ≤ 80 mmHg, and > 80 mmHg). Primary endpoint was cardiac death, secondary endpoint was 12-month all-cause death. Restricted cubic spline (RCS) and Cox models assessed PP-mortality associations after adjusting for confounders; PP-LVEF interaction was visualized via heatmap and 3D surface plot.
RESULTS: During follow-up, 37 all-cause deaths (1.67%) and 22 cardiac deaths (0.99%) were recorded. RCS confirmed a U-shaped PP-12-month mortality association (lowest risk: 41-60 mmHg). Multivariable analysis showed low PP (≤ 40 mmHg; adjusted HR = 18.21, 95% CI:1.65-201.01, P = 0.018) and high PP (> 80 mmHg; adjusted HR = 18.91, 95% CI:2.05-174.93, P = 0.010) independently predicted cardiac death. In LVEF ≤50% patients, extreme PP elevated cardiac death (P = 0.004) and all-cause death (P = 0.044); in LVEF >50% patients, only high PP increased outcomes (cardiac death: P = 0.034; all-cause death: P = 0.028), with low PP showing no significance.
CONCLUSIONS: Admission PP has a U-shaped association with 12-month mortality in post-PCI ACS patients. Reduced LVEF amplifies extreme PP's adverse effects. Integrated PP-LVEF assessment enhances risk stratification and guides personalized management.
METHODS: This observational study analyzed 2213 consecutive ACS patients from the BIPass study who underwent PCI. Patients were stratified by LVEF (>50% vs. ≤50%) and PP levels (≤ 40 mmHg, 40 < PP ≤ 60 mmHg, 60 < PP ≤ 80 mmHg, and > 80 mmHg). Primary endpoint was cardiac death, secondary endpoint was 12-month all-cause death. Restricted cubic spline (RCS) and Cox models assessed PP-mortality associations after adjusting for confounders; PP-LVEF interaction was visualized via heatmap and 3D surface plot.
RESULTS: During follow-up, 37 all-cause deaths (1.67%) and 22 cardiac deaths (0.99%) were recorded. RCS confirmed a U-shaped PP-12-month mortality association (lowest risk: 41-60 mmHg). Multivariable analysis showed low PP (≤ 40 mmHg; adjusted HR = 18.21, 95% CI:1.65-201.01, P = 0.018) and high PP (> 80 mmHg; adjusted HR = 18.91, 95% CI:2.05-174.93, P = 0.010) independently predicted cardiac death. In LVEF ≤50% patients, extreme PP elevated cardiac death (P = 0.004) and all-cause death (P = 0.044); in LVEF >50% patients, only high PP increased outcomes (cardiac death: P = 0.034; all-cause death: P = 0.028), with low PP showing no significance.
CONCLUSIONS: Admission PP has a U-shaped association with 12-month mortality in post-PCI ACS patients. Reduced LVEF amplifies extreme PP's adverse effects. Integrated PP-LVEF assessment enhances risk stratification and guides personalized management.