Pulse pressure in acute coronary syndromes: Comparative prognostic significance with systolic blood pressure
Background: Pulse pressure is a readily available vital sign that has been shown to independently predict outcomes in several cardiovascular disease states. We investigated the prognostic significance of pulse pressure (PP) and systolic blood pressure (SBP) among patients with acute coronary syndrom...
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| Veröffentlicht in: | European heart journal. Acute cardiovascular care 2019-06, Vol.8 (4), p.309-317 |
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| container_title | European heart journal. Acute cardiovascular care |
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| creator | Tan, Nigel S Sarak, Bradley Fox, Keith AA Brieger, David Steg, Ph. Gabriel Gale, Chris P Bhatt, Deepak L Spencer, Frederick A Grondin, Francois R Goodman, Shaun G Yan, Andrew T |
| description | Background:
Pulse pressure is a readily available vital sign that has been shown to independently predict outcomes in several cardiovascular disease states. We investigated the prognostic significance of pulse pressure (PP) and systolic blood pressure (SBP) among patients with acute coronary syndromes (ACS).
Methods:
A total of 14,514 patients with ACS in the prospective, multicentre Global Registry of Acute Coronary Events (GRACE), expanded GRACE (GRACE-2) and Canadian Registry of Acute Coronary Events (CANRACE) were stratified by initial PP on presentation. Patient characteristics and in-hospital outcomes were compared by PP quartiles and the independent prognostic significance of PP for in-hospital mortality was quantified. We compared the discriminative ability (c-statistic) of models incorporating either PP or SBP.
Results:
Patients with higher PPs were older, more frequently female and had higher prevalence rates of conventional cardiovascular risk factors (all p |
| doi_str_mv | 10.1177/2048872617700871 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1882498849</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_2048872617700871</sage_id><sourcerecordid>1882498849</sourcerecordid><originalsourceid>FETCH-LOGICAL-c379t-8ad811f5e256400309d7e06f64e9120508b591299c3fd935dd4fe6397b0954e63</originalsourceid><addsrcrecordid>eNp1UM9PwyAYJUbjFt3dk-HopQqFFvBmFn8lS_Sg54YCnSxtmXytZv-9LJs7mMiFF773Ht97CF1Qck2pEDc54VKKvEyYECnoEZpunzIpGD8-4LycoBnAiqQjSMklO0WTXLJCSJlPUfs6tuDwOjqAMTrse6zNODhsQgy9jhsMm97G0Dm4xfPQrXXUg__aKsKyDzB4g8Eve994o3vj8LcfPpIGhtCmUd2GYA_u5-ik0em72f4-Q-8P92_zp2zx8vg8v1tkhgk1ZFJbSWlTuLwoOSGMKCscKZuSO0VzUhBZFwkoZVhjFSus5Y0rmRI1UQVP6Axd7XzTkp-jg6HqPBjXtrp3YYSKpuhcSclVopId1cQAEF1TraPvUu6Kkmpbc_W35iS53LuPdefsQfBbaiJkOwLopatWYYx9Svu_4Q8dC4XO</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1882498849</pqid></control><display><type>article</type><title>Pulse pressure in acute coronary syndromes: Comparative prognostic significance with systolic blood pressure</title><source>MEDLINE</source><source>SAGE Journals</source><source>Oxford Journals</source><creator>Tan, Nigel S ; Sarak, Bradley ; Fox, Keith AA ; Brieger, David ; Steg, Ph. Gabriel ; Gale, Chris P ; Bhatt, Deepak L ; Spencer, Frederick A ; Grondin, Francois R ; Goodman, Shaun G ; Yan, Andrew T</creator><creatorcontrib>Tan, Nigel S ; Sarak, Bradley ; Fox, Keith AA ; Brieger, David ; Steg, Ph. Gabriel ; Gale, Chris P ; Bhatt, Deepak L ; Spencer, Frederick A ; Grondin, Francois R ; Goodman, Shaun G ; Yan, Andrew T ; Canadian GRACE/GRACE-2 and CANRACE Investigators ; on behalf of the Canadian GRACE/GRACE-2 and CANRACE Investigators</creatorcontrib><description>Background:
Pulse pressure is a readily available vital sign that has been shown to independently predict outcomes in several cardiovascular disease states. We investigated the prognostic significance of pulse pressure (PP) and systolic blood pressure (SBP) among patients with acute coronary syndromes (ACS).
Methods:
A total of 14,514 patients with ACS in the prospective, multicentre Global Registry of Acute Coronary Events (GRACE), expanded GRACE (GRACE-2) and Canadian Registry of Acute Coronary Events (CANRACE) were stratified by initial PP on presentation. Patient characteristics and in-hospital outcomes were compared by PP quartiles and the independent prognostic significance of PP for in-hospital mortality was quantified. We compared the discriminative ability (c-statistic) of models incorporating either PP or SBP.
Results:
Patients with higher PPs were older, more frequently female and had higher prevalence rates of conventional cardiovascular risk factors (all p < 0.01). Lower PP was associated with ST-segment elevation myocardial infarction presentation, higher GRACE risk scores and higher rates of adverse in-hospital outcomes (p < 0.001). PP was strongly correlated with SBP (Pearson’s correlation coefficient = 0.79, p < 0.001). After adjustment for other GRACE risk model predictors, lower PP was independently associated with in-hospital mortality (first vs. fourth quartile [reference]: adjusted odds ratio 2.57, 95% confidence interval 1.80–3.67). The c-statistic was slightly higher for the multivariable model incorporating SBP as compared to the model with PP (0.868 vs. 0.864, respectively, p = 0.028) for in-hospital mortality.
Conclusion:
Higher presenting PP is associated with increased age and more prevalent cardiovascular risk factors, whereas patients with lower PP present with worse clinical characteristics and in-hospital outcomes. Lower PP is an independent adverse prognosticator in ACS. However, PP did not improve the discriminatory performance of the GRACE risk score compared with SBP.</description><identifier>ISSN: 2048-8726</identifier><identifier>EISSN: 2048-8734</identifier><identifier>DOI: 10.1177/2048872617700871</identifier><identifier>PMID: 28357882</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - physiopathology ; Aged ; Blood Pressure - physiology ; Electrocardiography ; Female ; Follow-Up Studies ; Global Health ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Registries ; Risk Assessment - methods ; Risk Factors ; Survival Rate - trends ; Systole ; Time Factors</subject><ispartof>European heart journal. Acute cardiovascular care, 2019-06, Vol.8 (4), p.309-317</ispartof><rights>The European Society of Cardiology 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c379t-8ad811f5e256400309d7e06f64e9120508b591299c3fd935dd4fe6397b0954e63</citedby><cites>FETCH-LOGICAL-c379t-8ad811f5e256400309d7e06f64e9120508b591299c3fd935dd4fe6397b0954e63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2048872617700871$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2048872617700871$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28357882$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tan, Nigel S</creatorcontrib><creatorcontrib>Sarak, Bradley</creatorcontrib><creatorcontrib>Fox, Keith AA</creatorcontrib><creatorcontrib>Brieger, David</creatorcontrib><creatorcontrib>Steg, Ph. Gabriel</creatorcontrib><creatorcontrib>Gale, Chris P</creatorcontrib><creatorcontrib>Bhatt, Deepak L</creatorcontrib><creatorcontrib>Spencer, Frederick A</creatorcontrib><creatorcontrib>Grondin, Francois R</creatorcontrib><creatorcontrib>Goodman, Shaun G</creatorcontrib><creatorcontrib>Yan, Andrew T</creatorcontrib><creatorcontrib>Canadian GRACE/GRACE-2 and CANRACE Investigators</creatorcontrib><creatorcontrib>on behalf of the Canadian GRACE/GRACE-2 and CANRACE Investigators</creatorcontrib><title>Pulse pressure in acute coronary syndromes: Comparative prognostic significance with systolic blood pressure</title><title>European heart journal. Acute cardiovascular care</title><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><description>Background:
Pulse pressure is a readily available vital sign that has been shown to independently predict outcomes in several cardiovascular disease states. We investigated the prognostic significance of pulse pressure (PP) and systolic blood pressure (SBP) among patients with acute coronary syndromes (ACS).
Methods:
A total of 14,514 patients with ACS in the prospective, multicentre Global Registry of Acute Coronary Events (GRACE), expanded GRACE (GRACE-2) and Canadian Registry of Acute Coronary Events (CANRACE) were stratified by initial PP on presentation. Patient characteristics and in-hospital outcomes were compared by PP quartiles and the independent prognostic significance of PP for in-hospital mortality was quantified. We compared the discriminative ability (c-statistic) of models incorporating either PP or SBP.
Results:
Patients with higher PPs were older, more frequently female and had higher prevalence rates of conventional cardiovascular risk factors (all p < 0.01). Lower PP was associated with ST-segment elevation myocardial infarction presentation, higher GRACE risk scores and higher rates of adverse in-hospital outcomes (p < 0.001). PP was strongly correlated with SBP (Pearson’s correlation coefficient = 0.79, p < 0.001). After adjustment for other GRACE risk model predictors, lower PP was independently associated with in-hospital mortality (first vs. fourth quartile [reference]: adjusted odds ratio 2.57, 95% confidence interval 1.80–3.67). The c-statistic was slightly higher for the multivariable model incorporating SBP as compared to the model with PP (0.868 vs. 0.864, respectively, p = 0.028) for in-hospital mortality.
Conclusion:
Higher presenting PP is associated with increased age and more prevalent cardiovascular risk factors, whereas patients with lower PP present with worse clinical characteristics and in-hospital outcomes. Lower PP is an independent adverse prognosticator in ACS. However, PP did not improve the discriminatory performance of the GRACE risk score compared with SBP.</description><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - physiopathology</subject><subject>Aged</subject><subject>Blood Pressure - physiology</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Global Health</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Survival Rate - trends</subject><subject>Systole</subject><subject>Time Factors</subject><issn>2048-8726</issn><issn>2048-8734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1UM9PwyAYJUbjFt3dk-HopQqFFvBmFn8lS_Sg54YCnSxtmXytZv-9LJs7mMiFF773Ht97CF1Qck2pEDc54VKKvEyYECnoEZpunzIpGD8-4LycoBnAiqQjSMklO0WTXLJCSJlPUfs6tuDwOjqAMTrse6zNODhsQgy9jhsMm97G0Dm4xfPQrXXUg__aKsKyDzB4g8Eve994o3vj8LcfPpIGhtCmUd2GYA_u5-ik0em72f4-Q-8P92_zp2zx8vg8v1tkhgk1ZFJbSWlTuLwoOSGMKCscKZuSO0VzUhBZFwkoZVhjFSus5Y0rmRI1UQVP6Axd7XzTkp-jg6HqPBjXtrp3YYSKpuhcSclVopId1cQAEF1TraPvUu6Kkmpbc_W35iS53LuPdefsQfBbaiJkOwLopatWYYx9Svu_4Q8dC4XO</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Tan, Nigel S</creator><creator>Sarak, Bradley</creator><creator>Fox, Keith AA</creator><creator>Brieger, David</creator><creator>Steg, Ph. Gabriel</creator><creator>Gale, Chris P</creator><creator>Bhatt, Deepak L</creator><creator>Spencer, Frederick A</creator><creator>Grondin, Francois R</creator><creator>Goodman, Shaun G</creator><creator>Yan, Andrew T</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201906</creationdate><title>Pulse pressure in acute coronary syndromes: Comparative prognostic significance with systolic blood pressure</title><author>Tan, Nigel S ; Sarak, Bradley ; Fox, Keith AA ; Brieger, David ; Steg, Ph. Gabriel ; Gale, Chris P ; Bhatt, Deepak L ; Spencer, Frederick A ; Grondin, Francois R ; Goodman, Shaun G ; Yan, Andrew T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c379t-8ad811f5e256400309d7e06f64e9120508b591299c3fd935dd4fe6397b0954e63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - physiopathology</topic><topic>Aged</topic><topic>Blood Pressure - physiology</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Global Health</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Survival Rate - trends</topic><topic>Systole</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tan, Nigel S</creatorcontrib><creatorcontrib>Sarak, Bradley</creatorcontrib><creatorcontrib>Fox, Keith AA</creatorcontrib><creatorcontrib>Brieger, David</creatorcontrib><creatorcontrib>Steg, Ph. Gabriel</creatorcontrib><creatorcontrib>Gale, Chris P</creatorcontrib><creatorcontrib>Bhatt, Deepak L</creatorcontrib><creatorcontrib>Spencer, Frederick A</creatorcontrib><creatorcontrib>Grondin, Francois R</creatorcontrib><creatorcontrib>Goodman, Shaun G</creatorcontrib><creatorcontrib>Yan, Andrew T</creatorcontrib><creatorcontrib>Canadian GRACE/GRACE-2 and CANRACE Investigators</creatorcontrib><creatorcontrib>on behalf of the Canadian GRACE/GRACE-2 and CANRACE Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Acute cardiovascular care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tan, Nigel S</au><au>Sarak, Bradley</au><au>Fox, Keith AA</au><au>Brieger, David</au><au>Steg, Ph. Gabriel</au><au>Gale, Chris P</au><au>Bhatt, Deepak L</au><au>Spencer, Frederick A</au><au>Grondin, Francois R</au><au>Goodman, Shaun G</au><au>Yan, Andrew T</au><aucorp>Canadian GRACE/GRACE-2 and CANRACE Investigators</aucorp><aucorp>on behalf of the Canadian GRACE/GRACE-2 and CANRACE Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pulse pressure in acute coronary syndromes: Comparative prognostic significance with systolic blood pressure</atitle><jtitle>European heart journal. Acute cardiovascular care</jtitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><date>2019-06</date><risdate>2019</risdate><volume>8</volume><issue>4</issue><spage>309</spage><epage>317</epage><pages>309-317</pages><issn>2048-8726</issn><eissn>2048-8734</eissn><abstract>Background:
Pulse pressure is a readily available vital sign that has been shown to independently predict outcomes in several cardiovascular disease states. We investigated the prognostic significance of pulse pressure (PP) and systolic blood pressure (SBP) among patients with acute coronary syndromes (ACS).
Methods:
A total of 14,514 patients with ACS in the prospective, multicentre Global Registry of Acute Coronary Events (GRACE), expanded GRACE (GRACE-2) and Canadian Registry of Acute Coronary Events (CANRACE) were stratified by initial PP on presentation. Patient characteristics and in-hospital outcomes were compared by PP quartiles and the independent prognostic significance of PP for in-hospital mortality was quantified. We compared the discriminative ability (c-statistic) of models incorporating either PP or SBP.
Results:
Patients with higher PPs were older, more frequently female and had higher prevalence rates of conventional cardiovascular risk factors (all p < 0.01). Lower PP was associated with ST-segment elevation myocardial infarction presentation, higher GRACE risk scores and higher rates of adverse in-hospital outcomes (p < 0.001). PP was strongly correlated with SBP (Pearson’s correlation coefficient = 0.79, p < 0.001). After adjustment for other GRACE risk model predictors, lower PP was independently associated with in-hospital mortality (first vs. fourth quartile [reference]: adjusted odds ratio 2.57, 95% confidence interval 1.80–3.67). The c-statistic was slightly higher for the multivariable model incorporating SBP as compared to the model with PP (0.868 vs. 0.864, respectively, p = 0.028) for in-hospital mortality.
Conclusion:
Higher presenting PP is associated with increased age and more prevalent cardiovascular risk factors, whereas patients with lower PP present with worse clinical characteristics and in-hospital outcomes. Lower PP is an independent adverse prognosticator in ACS. However, PP did not improve the discriminatory performance of the GRACE risk score compared with SBP.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>28357882</pmid><doi>10.1177/2048872617700871</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal. Acute cardiovascular care, 2019-06, Vol.8 (4), p.309-317 |
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| language | eng |
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| source | MEDLINE; SAGE Journals; Oxford Journals |
| subjects | Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - mortality Acute Coronary Syndrome - physiopathology Aged Blood Pressure - physiology Electrocardiography Female Follow-Up Studies Global Health Humans Male Middle Aged Prognosis Prospective Studies Registries Risk Assessment - methods Risk Factors Survival Rate - trends Systole Time Factors |
| title | Pulse pressure in acute coronary syndromes: Comparative prognostic significance with systolic blood pressure |
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