Cor Vasa 2005, 46(3)

Effect of hypertension on 30-day outcomes of patients with acute myocardial infarction treated by thrombolysis or primary PCI. Analysis of PRAGUE-2 trial patients

Petr Widimský^1,*, Dana Bílková¹, David Voráč¹, Ladislav Groch², Tomáš Buděšínský¹, Michael Aschermann³, Michael Želízko⁴

¹ Kardiocentrum, Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha

² I. interní-kardioangiologická klinika, Fakultní nemocnice u svaté Anny a Lékařská fakulta Masarykovy Univerzity, Brno

³ II. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy

⁴ Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

The effect of hypertension on the risk of stroke has been shown by many trials. The effect of hypertension on the risk of myocardial infarction is less clear. The aim of this study was to compare the 30-day outcome of patients with hypertension vs. normotensive subjects among patients with acute ST elevation myocardial infarction, randomized in the PRAGUE-2 trial.

Methods:
The PRAGUE-2 trial randomized, between 1999 and 2002, a total of 850 patients with acute ST-elevation myocardial infarction into two groups: streptokinase infusion in the nearest hospital (TL, N = 421) vs. immediate transport for primary percutaneous coronary intervention (PCI, N = 429). The history of hypertension before randomization could not be obtained in 11 patients. Thus, this paper analyzes the data of 839 patients. There were 47% of hypertensive subjects in the TL group vs. 49% in the PCI group (NS). The mean age of hypertensives was 65 ±12 and that of normotensives 63 ±11 years (p < 0.05). Diabetes mellitus was present in 28% of hypertensives and 17% of normotensives (p < 0.05).

Results:
The mean value of peak CK-MB after TL was 1,049 U in hypertensives and 1,149 U (NS) in normotensives; after PCI these values reached only 412 U (hypertensives) and 515 U (normotensives, NS). The mean ejection fraction (EF) after TL was 49.7% in hypertensives vs. 48.6% in normotensives (NS). In the PCI group, EF was 49.9% in hypertensives vs. 50.4% in normotensives (NS). Exertional dyspnoe (using NYHA classification) did not differ among subgroups (TL: 1.49 in hypertensives vs. 1.39 in normotensives; PCI: 1.42 in hypertensives vs. 1.35 in normotensives, NS). The clinical end-points are shown in Table I.

Conclusion:
Hypertensive patients with acute myocardial infarction, treated by thrombolysis, are at higher risk of death or stroke compared to normotensive subjects treated by thrombolysis or to all subjects treated by primary PCI. All hypertensive patients with acute ST-elevation myocardial infarction should be treated by primary PCI. Thrombolysis could only be a therapeutic alternative for patients without hypertension.

Keywords: Myocardial infarction; Hypertension; Thrombolysis; Primary PCI

Published: March 1, 2005  Show citation