Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction

David Carrick; Caroline Haig; Annette M. Maznyczka; Jaclyn Carberry; Kenneth Mangion; Nadeem Ahmed; Vannesa Teng Yue May; Margaret McEntegart; Mark C. Petrie; Hany Eteiba; Mitchell Lindsay; Stuart Hood; Stuart Watkins; Andrew Davie; Ahmed Mahrous; Ify Mordi; Ian Ford; Aleksandra Radjenovic; Paul Welsh; Naveed Sattar; Kirsty Wetherall; Keith G. Oldroyd; Colin Berry

doi:10.1161/HYPERTENSIONAHA.117.10786

Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction

David Carrick
, Caroline Haig
, Annette M. Maznyczka
, Jaclyn Carberry
, Kenneth Mangion
, Nadeem Ahmed
, Vannesa Teng Yue May
, Margaret McEntegart
, Mark C. Petrie
, Hany Eteiba
, Mitchell Lindsay
, Stuart Hood
, Stuart Watkins
, Andrew Davie
, Ahmed Mahrous
, Ify Mordi
, Ian Ford
, Aleksandra Radjenovic
, Paul Welsh
, Naveed Sattar

Kirsty Wetherall, Keith G. Oldroyd, Colin Berry

Research output: Contribution to journal › Article › peer-review

49 Citations (Scopus)

260 Downloads (Pure)

Abstract

The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.

Original language	English
Pages (from-to)	720-730
Number of pages	11
Journal	Hypertension (Dallas, Tex. : 1979)
Volume	72
Issue number	3
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.117.10786
Publication status	Published - 1 Sept 2018

Keywords

atherosclerosis
hypertension
myocardial infarction
prognosis
reperfusion injury

ASJC Scopus subject areas

Internal Medicine

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10.1161/HYPERTENSIONAHA.117.10786Licence: CC BY

Final Published VersionFinal published version, 300 KBLicence: CC BY

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Carrick, D., Haig, C., Maznyczka, A. M., Carberry, J., Mangion, K., Ahmed, N., Yue May, V. T., McEntegart, M., Petrie, M. C., Eteiba, H., Lindsay, M., Hood, S., Watkins, S., Davie, A., Mahrous, A., Mordi, I., Ford, I., Radjenovic, A., Welsh, P., ... Berry, C. (2018). Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction. Hypertension (Dallas, Tex. : 1979), 72(3), 720-730. https://doi.org/10.1161/HYPERTENSIONAHA.117.10786

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abstract = "The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73\%] male, 105 [32\%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50\%] versus 144 [66\%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]\% versus 7.4 [7.6]\%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.",

keywords = "atherosclerosis, hypertension, myocardial infarction, prognosis, reperfusion injury",

author = "David Carrick and Caroline Haig and Maznyczka, \{Annette M.\} and Jaclyn Carberry and Kenneth Mangion and Nadeem Ahmed and \{Yue May\}, \{Vannesa Teng\} and Margaret McEntegart and Petrie, \{Mark C.\} and Hany Eteiba and Mitchell Lindsay and Stuart Hood and Stuart Watkins and Andrew Davie and Ahmed Mahrous and Ify Mordi and Ian Ford and Aleksandra Radjenovic and Paul Welsh and Naveed Sattar and Kirsty Wetherall and Oldroyd, \{Keith G.\} and Colin Berry",

note = "This study was supported by the British Heart Foundation (BHF) Centre of Research Excellence Award (RE/13/5/30177), the BHF Project Grant PG/11/2/28474, the National Health Service, and the Chief Scientist Office. C. Berry was supported by a Senior Fellowship from the Scottish Funding Council. P. Welsh is supported by BHF Fellowship FS/12/62/29889. A.M. Maznyczka is supported by BHF Fellowship FS/16/74/32573.",

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doi = "10.1161/HYPERTENSIONAHA.117.10786",

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Carrick, D, Haig, C, Maznyczka, AM, Carberry, J, Mangion, K, Ahmed, N, Yue May, VT, McEntegart, M, Petrie, MC, Eteiba, H, Lindsay, M, Hood, S, Watkins, S, Davie, A, Mahrous, A, Mordi, I, Ford, I, Radjenovic, A, Welsh, P, Sattar, N, Wetherall, K, Oldroyd, KG & Berry, C 2018, 'Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction', Hypertension (Dallas, Tex. : 1979), vol. 72, no. 3, pp. 720-730. https://doi.org/10.1161/HYPERTENSIONAHA.117.10786

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T1 - Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction

AU - Carrick, David

AU - Haig, Caroline

AU - Maznyczka, Annette M.

AU - Carberry, Jaclyn

AU - Mangion, Kenneth

AU - Ahmed, Nadeem

AU - Yue May, Vannesa Teng

AU - McEntegart, Margaret

AU - Petrie, Mark C.

AU - Eteiba, Hany

AU - Lindsay, Mitchell

AU - Hood, Stuart

AU - Watkins, Stuart

AU - Davie, Andrew

AU - Mahrous, Ahmed

AU - Mordi, Ify

AU - Ford, Ian

AU - Radjenovic, Aleksandra

AU - Welsh, Paul

AU - Sattar, Naveed

AU - Wetherall, Kirsty

AU - Oldroyd, Keith G.

AU - Berry, Colin

N1 - This study was supported by the British Heart Foundation (BHF) Centre of Research Excellence Award (RE/13/5/30177), the BHF Project Grant PG/11/2/28474, the National Health Service, and the Chief Scientist Office. C. Berry was supported by a Senior Fellowship from the Scottish Funding Council. P. Welsh is supported by BHF Fellowship FS/12/62/29889. A.M. Maznyczka is supported by BHF Fellowship FS/16/74/32573.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.

AB - The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.

KW - atherosclerosis

KW - hypertension

KW - myocardial infarction

KW - prognosis

KW - reperfusion injury

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DO - 10.1161/HYPERTENSIONAHA.117.10786

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JO - Hypertension (Dallas, Tex. : 1979)

JF - Hypertension (Dallas, Tex. : 1979)

IS - 3

ER -

Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction

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Keywords

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