| Background:PP has emerged to be a powerful predictive factor for cardiovascular events in specific populations.An inverse relationship between PP and adverse cardiovascular outcomes had been discovered in patient with heart failure,and a growing number of studies had aimed on the impact of left ventricular ejection fraction(LVEF)on this association.But there is also a lack of reliable information about the comprehensive predictive effect of PP and left ventricular ejection fraction(LVEF)in patients with ACS and performed PCI.Therefore,we aimed to evaluate the combined effects between PP on admission and LVEF on the long-term outcomes of patients who were diagnosed with ACS and performed PCI.Objective:This study aimed to evaluate the predictive value of pulse pressure(PP)at different left ventricular function status on the long-term outcomes in patients with acute coronary syndromes(ACS)and performed percutaneous coronary intervention(PCI).Methods:We conducted a retrospective cohort study in ACS patients performed PCI in the chest pain center of Qilu Hospital,Shandong University.Baseline characteristics were presented as numbers and percentages for categorical variables,means ± standard deviations(SDs)or medians with interquartile range(25th,75th),as appropriate for continuous variables.The baseline characteristics of groups were compared by the chi-square test for categorical variables,Student’s t-test or Kruscal-wallis test for continuous variables.To assess the(crude)functional form of PP with mortality and PP with MACE,a restricted cubic spline(RCS)based on Cox proportional hazard models were built in overall population.Additionally,to identify the predictive effects of PP on mortality and MACE at different LVEF status,we fitted adjusted Cox proportional hazards regression models separately for an 18-months outcome in the overall population,low LVEF group(≤50%)and normal LVEF group(>50%).Cutoff ranges for each of the PP quartiles were defined as follows:quartile 1,≤40 mm Hg;quartile 2,40<PP≤60 mm Hg;quartile 3,>60 mm Hg.Results:In this study,we discovered PP had a non-linear crude relationship with 18-months outcomes in overall population with a risk nadir at PP around 41-60mmHg.In addition,we found the predictive effect of PP on outcomes was remarkable in all-cause mortality,less in MACE after adjustment,and low PP(≤40mmHg)was independently related to all-cause mortality in overall ACS patients.In addition,we observed that the association between PP and 18-months outcomes was a complex function of LVEF status,and LVEF group modified the relationship between PP and 18-month outcomes.When considering LVEF into analysis,low PP(≤40mmHg)in low LVEF group(≤50%)but normal LVEF group(>50%)was distinctively related to high incidence of all-cause death and MACEConclusions:The predictive effect of PP on outcomes was remarkable in all-cause mortality,less in MACE,and low PP(≤40mmHg)was distinctively related to high incidence of all-cause death and MACE especially in patients with low LVEF. |
