Impact of hypertension on mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty: insights from the international multicenter ISACS-STEMI registry
Authors: De Luca Giuseppe , Nardin Matteo , Algowhary Magdy , Uguz Berat , Oliveira Dinaldo C. , Ganyukov Vladimir , Zimbakov Zan , Cercek Miha , Okkels Jensen Lisette , Loh Poay Huan , Calmac Lucian , Roura i Ferrer Gerard , Quadros Alexandre , Milewski Marek , Scotto D’Uccio Fortunato , von Birgelen Clemens , Versaci Francesco , Ten Berg Jurrien , Casella Gianni , Lung Aaron Wong Sung , Kala Petr , Díez Gil José Luis , Carrillo Xavier , Dirksen Maurits , Becerra-Munoz Victor M. , Lee Michael Kang-yin , Juzar Dafsah Arifa , Moura Joaquim Rodrigo de , Paladino Roberto , Milicic Davor , Davlouros Periklis , Bakraceski Nikola , Zilio Filippo , Donazzan Luca , Kraaijeveld Adriaan , Galasso Gennaro , Lux Arpad , Marinucci Lucia , Guiducci Vincenzo , Menichelli Maurizio , Scoccia Alessandra , Yamac Aylin Hatice , Mert Kadir Ugur , Flores Rios Xacobe , Kovarnik Tomas , Kidawa Michal , Moreu Josè , Flavien Vincent , Fabris Enrico , Lozano Martínez-Luengas Iñigo , Boccalatte Marco , Bosa Ojeda Francisco , Arellano-Serrano Carlos , Caiazzo Gianluca , Cirrincione Giuseppe , Kao Hsien-Li , Sanchis Forés Juan , Vignali Luigi , Pereira Helder , Manzo Stephane , Ordoñez Santiago , Arat Özkan Alev , Scheller Bruno , Lehtola Heidi , Teles Rui , Mantis Christos , Antti Ylitalo , Brum Silveira João António , Zoni Rodrigo , Bessonov Ivan , Savonitto Stefano , Kochiadakis George , Alexopulos Dimitrios , Uribe Carlos E , Kanakakis John , Faurie Benjamin , Gabrielli Gabriele , Gutierrez Barrios Alejandro , Bachini Juan Pablo , Rocha Alex , Tam Frankie Chor-Cheung , Rodriguez Alfredo , Lukito Antonia Anna , Saint-Joy Veauthyelau , Pessah Gustavo , Parodi Guido , Burgadha Mohammed Abed , Kedhi Elvin , Lamelas Pablo , Suryapranata Harry , Verdoia Monica 
Published: October 2024

Background:
Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.

Methods:
The ISACS-STEMI COVID-19 was a retrospective registry that included STEMI patients treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 in 109 high-volume primary PCI centers from 4 continents. We collected data on baseline, clinical and procedural characteristics, in-hospital outcome and 30-day mortality. For this analysis patients were grouped according to history of hypertension at admission.

Results:
A total of 16083 patients were assessed, including 8813 (54.8%) with history of hypertension. These patients were more often elderly, with a worse cardiovascular risk profile, but were less frequently active smoker. Some procedural differences were observed between the two groups, including lower rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor but more extensive coronary disease in patients with hypertension. Between patients with and without hypertension, there was no significant difference in SARS-CoV-2 positivity. Hypertensive patients had a significantly higher in-hospital and 30-day mortality, similarly observed in both pre-COVID-19 and COVID-19 era, and confirmed after adjustment for main baseline differences and propensity score (in-hospital mortality: adjusted odds ratio (OR) [95% confidence interval (CI)] =1.673 [1.389–2.014], P < 0.001; 30-day mortality: adjusted hazard ratio (HR) [95% CI] = 1.418 [1.230–1.636], P < 0.001).

Conclusion:
This is one of the largest and contemporary study assessing the impact of hypertension in STEMI patients undergoing primary angioplasty, including also the COVID-19 pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-day mortality.