A268JACC April 1, 2014

Volume 63, Issue 12

Acute Coronary Syndromes

u-Shaped relationShip oF blood preSSure and outComeS aFter aCute myoCardial inFarCtion

Poster ContributionsHall CMonday, March 31, 2014, 9:45 a.m.-10:30 a.m.

Session Title: Acute Coronary Syndromes: Biologic ConsiderationsAbstract Category: 1. Acute Coronary Syndromes: ClinicalPresentation Number: 1265-262

Authors: Sen Matsumoto, Yasuhiko Sakata, Daisaku Nakatani, Shinichiro Suna, Masaya Usami, Masahiko Hara, Tetsuhisa Kitamura, Shinsuke Nanto, Issei Komuro, Osaka University Graduate School of Medicine, Suita, Japan

background: Optimal target range (OTR) of systolic blood pressure (SBP) should be determined among patients after acute myocardial infarction (AMI).

methods: Using the survival Classification and Regression Trees (CART) analysis, we explored the OTR of SBP in 4,219 first AMI survivors registered to the Osaka Acute Coronary Insufficiency Study (OACIS) (Mean age 66 years, and male 76%).

results: The survival CART analysis revealed the first and second discriminating SBP levels at discharge to discern the best heart failure (HF)-free survival as 103 and 139mmHg, respectively, identifying SBP range of 103-139mmHg as OTR with the highest HF-free survival determined by the Kaplan Meier curves and multivariate Cox regression analysis (Figure). Moreover, OTR of SBP varied a little according to the subgroups such as those with diabetes or chronic kidney disease (Figure).

Conclusion: The survival CART analysis demonstrated the OTR of SBP as 103-139mmHg at discharge, suggesting the U-shaped curve association between SBP and cardiovascular risks in post-AMI patients.