Abstract 2615: A Low Pulse Pressure Predicts Mortality In Patients With Left Ventricular Dysfunction Post Myocardial Infarction, But Only In Those With Signs And Symptoms Of Heart Failure.
Introduction: A high pulse pressure (PP) is related to poor outcome in patients with cardiovascular disease, but a low PP is related to poor outcome in chronic heart failure patients. We therefore aimed to compare the prognostic value of pulse pressure in post myocardial infarction patients with and without signs and symptoms of heart failure.
Methods: A total of 1959 patients from the CAPRICORN clinical trial were randomised to carvedilol or placebo between 3 and 21 days post myocardial infarction (MI) with a left ventricular ejection fraction (LVEF) ≤40%. Mean follow-up was 1.3 years. Multivariable Cox proportional hazard analyses were performed for all cause mortality, cardiovascular mortality and sudden death. PP was adjusted for other baseline risk factors including mean arterial pressure and study treatment.
Results: Overall mean age was 63 years, LVEF 33%, BP 121/74 and 73% were male. Intravenous diuretics and nitrates were required in 33% and 75% respectively during the index MI. In patients with Killip Class I heart failure (n=1342), PP and MAP were not predictive for any outcome, and carvedilol did not significantly reduce any of these endpoints. However in patients in Killip Class II–IV (n = 613), a low PP predicted all cause mortality (HR 0.83 per 10mm Hg; CI 0.71– 0.98; p=0.0252), cardiovascular mortality (HR 0.83; CI 0.70 – 0.98; p=0.0245) and sudden death (HR 0.77; CI 0.60 –1.00; p=0.0470). In Killip Class II–IV, treatment with carvedilol was associated with improved outcome, HR 0.68 for all cause mortality (CI 0.47– 0.99; p=0.0455), principally due to a reduction in cardiovascular mortality (HR 0.66; CI 0.44 – 0.97; p=0.0353).
Conclusion: A low pulse pressure is an independent predictor of mortality in subjects with depressed left ventricular ejection fraction after a myocardial infarction and signs and symptoms of heart failure. These results are in keeping with recent published data of a lower PP as an adverse predictor in those with more symptomatic heart failure.