Determining the Association between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients with Acute Myocardial Infarction: A Prospective Study

M. Lamhani *

Department of Cardiology, Mohammed VI University Hospital, Marrakech, Morocco.

I. Katif

Department of Cardiology, Mohammed VI University Hospital, Marrakech, Morocco.

Mohammed El Jamili

Department of Cardiology, Mohammed VI University Hospital, Marrakech, Morocco.

Saloua El Karimi

Department of Cardiology, Mohammed VI University Hospital, Marrakech, Morocco.

Mustapha El Hattaoui

Department of Cardiology, Mohammed VI University Hospital, Marrakech, Morocco.

*Author to whom correspondence should be addressed.


Abstract

Acute myocardial infarction (AMI) is a challenging cardiovascular disease leading to a high rate of mortality. Some cardiomyocytes in AMI were affected by ischemia and necrosis, resulting in a decrease in myocardial contractility, an acute proinflammatory response, and an increase in sympathetic tone. In the meantime, proinflammation and endothelial dysfunction are induced by high blood pressure variability (BPV), which increases left ventricular workload, heart rate, and myocardial oxygen demand. As a result, a high BPV and the pathological effects it causes are likely to affect the onset of acute cardiac complications in AMI and the physiological function of the heart [1]. Patients Pulse changeability (BPV) has been fundamentally concentrated on through the crystal of congestive cardiovascular breakdown (CHF) and hypertension, yet not in that frame of mind of an intense coronary condition (ACS). This study means to explore the relationship between transient BPV and major unfavorable heart occasions (MACE) in AMI patients. The following order can be used to define MACEs: Death > shock > cerebrovascular stroke > heart failure > hypertensive crisis > life-threatening arrhythmias .This prospective study used the weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings to include 74 patients who were hospitalized in the cardiology department at ARRAZI hospital MOHAMED VI, MARRAKECH between September 2022 and February 2023.

Results: The average systolic BPV value which was estimated as standard deviation (SD) and average real variability (ARV) was more significant in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 12,78 mmHg and 11,61 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.45 mmHg and 7,23 mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE, unlike patients who didn’t experienced MACE for whom the ARV was nearly the same for patient with and without HBP.

Conclusion: MACE was higher in the group BPV of AMI patients than that of non-MACE AMI patients. There was no significant association between BPV ​​and MACE during the acute phase of AMI, however the BPV was significantly more important for HBP patient who experienced MACE, which leads us to think that the screening of BPV in HBP patient may by a predictive factor for the development of MACEs.

Keywords: Acute myocardial infarction, ambulatory BP monitoring, blood pressure variability, major adverse cardiac events (MACE)


How to Cite

Lamhani , M., I. Katif, Mohammed El Jamili, Saloua El Karimi, and Mustapha El Hattaoui. 2023. “Determining the Association Between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients With Acute Myocardial Infarction: A Prospective Study”. Cardiology and Angiology: An International Journal 12 (3):135-40. https://doi.org/10.9734/ca/2023/v12i3336.

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References

Harefa et al. The association between 24-h blood pressure variability and Major Adverse Cardiac Events (MACE) in hospitalized patients with acute myocardial infarction: A retrospective cohort study. Egypt. Heart J. 2021;73(1):88.

DOI: 10.1186/s43044-021-00213-1

Bilo G, et al. A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J. Hypertens. 2007; 25(10):2058‑2066. DOI: 10.1097/HJH.0b013e32829c6a60

Kinsara AJ. Ambulatory blood pressure monitoring in daily practice. Indian Heart J. 2017;69(6):788‑789.

DOI: 10.1016/j.ihj.2017.09.223

Rosendorff C, Writing Committee. Treatment of hypertension in patients with coronary artery disease. A case-based summary of the 2015 AHA/ACC/ASH scientific statement. Am. J. Med. 2016; 129(4):372‑378. DOI: 10.1016/j.amjmed.2015.10.045

Collet JP, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J. 2021;42(14):1289‑1367.DOI: 10.1093/eurheartj/ehaa575

Ibánez B, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev. Espanola Cardiol. Engl. Ed. 2017;70(12):1082.DOI: 10.1016/j.rec.2017.11.010

Samsky MD, et al. Cardiogenic shock after acute myocardial infarction: A review. JAMA. 2021;326(18): 1840‑1850.

DOI: 10.1001/jama.2021.18323

Terént A, Andersson B. The prognosis for patients with cerebrovascular stroke and transient ischemic attacks. Ups. J. Med. Sci. 1981;86(1):63‑74. DOI: 10.3109/03009738109179211

Suneja M, Sanders ML. Hypertensive emergency. Med. Clin. North Am. 2017; 101(3):465‑478. DOI: 10.1016/j.mcna.2016.12.007.

Aggarwal A, Rohit MK, Talwar KK. Managing arrhythmia in acute myocardial infarction. Indian Heart J. 2011;63(1): 98‑103.

World Bank Open Data. World Bank Open Data. Available:https://data.worldbank.org Access on 18 april 2023

Moustaghfir A, Haddak M, Mechmeche R. Management of acute coronary syndromes in Maghreb countries: The ACCESS (acute coronary events - a multinational survey of current management strategies) registry. Arch. Cardiovasc. Dis. 2012;105(11): 566‑577. DOI: 10.1016/j.acvd.2012.07.002

Sari D, et al. Hubungan antara depresi dan ansietas dengan Major Adverse Cardiac Event (MACE) dalam 7 hari pada pasien sindrom koroner akut di RSCM. J. Penyakit Dalam Indones. 2019;5. DOI: 10.7454/jpdi.v5i4.186

Cuspidi C, Tadic M, Grassi G. Short‐term blood pressure variability in acute coronary syndrome. J. Clin. Hypertens. 2017;19(12): 1249‑1251. DOI: 10.1111/jch.13105

Hassan AKM, et al. Impact of in-hospital blood pressure variability on cardiovascular outcomes in patients with acute coronary syndrome. J. Clin. Hypertens. Greenwich Conn. 2017 ;19(12): 1252‑1259. DOI: 10.1111/jch.13107