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Elevated sPAP a Mortality Risk Factor in Elderly MI Patients

This is a summary of a preprint research study by Salim Barywani, MD, PhD, from the University of Gothenburg, Sweden, and colleagues published on Research Square and provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on researchsquare.com

Key Takeaway

  • Elderly patients with elevated systolic pulmonary artery pressure (sPAP) with a cutoff level at ≥40 mm Hg had a twofold increased risk for both 1- and 5-year all-cause mortality after myocardial infarction (MI), in an observational study.

Why This Matters

  • The study demonstrates that elevated sPAP is an independent risk factor for all-cause mortality in patients age 80 years or older with acute MI. As sPAP increases so does the risk for all-cause mortality. Elevated sPAP may be a better prognostic factor for death among these patients than left ventricular ejection fraction (LVEF), and treatment for patients with elevated sPAP after acute MI may improve survival rates, the authors conclude.

Study Design

  • Of 353 patients aged 80 years or older hospitalized between 2006-2007 as a result of acute coronary syndrome at two major cardiology departments in Sweden, 162 patients who had an acute MI were examined using echocardiography with adequate data on sPAP, and were followed-up for mortality over 5 years.

  • Using the Swedish Cause of Death registry, investigators reported on 1- and 5-year all-cause mortality after acute MI.

Key Results

  • Patients with sPAP ≥40 mm Hg had a higher 5-year mortality rate (69.6%, 46 events vs 41.6%, 40 events, P < .001) and 1-year mortality rate (34.8%, 23 events vs 15.6%, 15 events, P = .004), compared with patients with sPAP <40 mm Hg.   

  • There was an association between elevated sPAP with a cutoff level at ≥40 mm Hg and increased 1-year all-cause mortality (hazard ratio [HR], 2.63; 95% CI, 1.19 – 5.84, P = .017) as well as 5-year all-cause mortality (HR, 2.08; 95% CI 1.25 – 3.44, P = .005).

  • Every increase of 5 mm Hg in sPAP was associated with a 2.5% increased risk for all-cause mortality (HR, 1.02, 95% CI 1.00 – 1.05, P = .05) for 1-year follow-up and a 3% increased risk for all-cause mortality (HR, 1.03; 95% CI, 1.01 – 1.04, P = .003) at 5-year follow-up.

  • Male gender, atrial fibrillation, and an estimated glomerular filtration rate of ≤35 ml/min/1.73m2 were also associated with increased 5-year mortality, whereas treatment with percutaneous coronary intervention was associated with decreased mortality. At 1 year, sPAP of >40 mm Hg was the only independent predictor of mortality, indicating that “these patients with elevated sPAP have a high risk for impaired survival already during the first year, and these patients must be identified and tailored for secondary intervention managements as soon as possible,” the authors write.

  • There was no statistical relationship of LVEF with either 1- or 5-year mortality.

Limitations

  • Some patient data were not available and medical records were studied retrospectively.

  • Even with adjustment, residual confounding from unmeasured variables could not be ruled out.

  • Right heart catheterization would be the gold standard for measuring pulmonary artery pressure, but approximation of the right atrial pressure using inferior vena cava width and its respiratory variables was used.

Study Disclosures

  • No conflict of interest disclosed.

  • The study was supported by grants from the Västra Götalandsregionen, Sweden.

Preprint Research Study: Impact of Elevated Systolic Arterial Pulmonary Pressure on Short and Long Term All-Cause Mortality After Acute Myocardial Infarction in the Elderly | Research Square

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