Higher incidence of hypotension episodes in women during the
sub-acute phase of ST elevation myocardial infarction and
relationship to covariates

J 2017

Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates

KALA, Petr, Tomáš NOVOTNÝ, Irena ANDRŠOVÁ, Klára BENEŠOVÁ, Mária HOLICKÁ et. al.

Basic information

Original name

Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates

Authors

KALA, Petr (203 Czech Republic, belonging to the institution), Tomáš NOVOTNÝ (203 Czech Republic, belonging to the institution), Irena ANDRŠOVÁ (203 Czech Republic, belonging to the institution), Klára BENEŠOVÁ (203 Czech Republic, belonging to the institution), Mária HOLICKÁ (703 Slovakia, belonging to the institution), Jiří JARKOVSKÝ (203 Czech Republic, belonging to the institution), Katerina HNATKOVA (203 Czech Republic), Lumír KOC (203 Czech Republic, belonging to the institution), Monika MIKOLÁŠKOVÁ (703 Slovakia, belonging to the institution), Tereza NOVÁKOVÁ (203 Czech Republic, belonging to the institution), Tomáš ONDRÚŠ (703 Slovakia, belonging to the institution), Lenka PŘÍVAROVÁ (203 Czech Republic), Jindřich ŠPINAR (203 Czech Republic, belonging to the institution) and Marek MALIK (203 Czech Republic)

Edition

Plos one, San Francisco, Public Library of Science, 2017, 1932-6203

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 2.766

RIV identification code

RIV/00216224:14110/17:00098303

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1371/journal.pone.0173699

UT WoS

000396087900030

Keywords in English

sub-acute phase of ST elevation myocardial infarction

Abstract

V originále

Objective The introduction of primary percutaneous coronary intervention (PPCI) has modified the profile of ST elevation myocardial infarction (STEMI) patients. Occurrence and prognostic significance of hypotension episodes are not known in PPCI treated STEMI patients. It is also not known whether and/or how the hypotension episodes correlate with the degree of myocardial damage and whether there are any sex differences. Methods Data of 293 consecutive STEMI patients (189 males) treated by PPCI and without cardiogenic shock were analyzed. Blood pressure was measured noninvasively. A hypotensive episode was defined as a systolic blood pressure below 90 mmHg over a period of at least 30 minutes. Results A hypotensive episode was observed in 92 patients (31.4%). Female sex was the strongest independent predictor of hypotension episodes (p < 0.0001), while there was no relationship to electrocardiographic STEMI localization. Hypotensive patients had significantly higher levels of troponin T and brain natriuretic peptide; hypotensive episodes were particularly frequent in women with increased troponin T. Treatment with angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB) and betablockers was less frequent in hypotensive patients. After a mean 20-month follow-up, all-cause mortality did not differ between hypotensive patients and others. However, mortality in hypotensive patients who did not tolerate ACEI/ARB therapy was significantly higher compared to other hypotensive patients (p = 0.016). Conclusion Hypotension episodes are not uncommon in the sub-acute phase of contemporarily treated STEMI patients with a striking difference between sexes-female sex was the strongest independent predictor of hypotension episodes. Hypotensive episodes may lead to a delay in pharmacotherapy which influences prognosis. Higher incidence of hypotension in women could at least partially explain the sex-related differences in the use of cardiovascular pharmacotherapy which was repeatedly observed in various studies.

Citovat

KALA, Petr, Tomáš NOVOTNÝ, Irena ANDRŠOVÁ, Klára BENEŠOVÁ, Mária HOLICKÁ, Jiří JARKOVSKÝ, Katerina HNATKOVA, Lumír KOC, Monika MIKOLÁŠKOVÁ, Tereza NOVÁKOVÁ, Tomáš ONDRÚŠ, Lenka PŘÍVAROVÁ, Jindřich ŠPINAR and Marek MALIK. Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates. Plos one. San Francisco: Public Library of Science, 2017, vol. 12, No 3, p. 1-12. ISSN 1932-6203. Available from: https://dx.doi.org/10.1371/journal.pone.0173699.

@article{1395661,
   author = {Kala, Petr and Novotný, Tomáš and Andršová, Irena and Benešová, Klára and Holická, Mária and Jarkovský, Jiří and Hnatkova, Katerina and Koc, Lumír and Mikolášková, Monika and Nováková, Tereza and Ondrúš, Tomáš and Přívarová, Lenka and Špinar, Jindřich and Malik, Marek},
   article_location = {San Francisco},
   article_number = {3},
   doi = {http://dx.doi.org/10.1371/journal.pone.0173699},
   keywords = {sub-acute phase of ST elevation myocardial infarction},
   language = {eng},
   issn = {1932-6203},
   journal = {Plos one},
   title = {Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates},
   volume = {12},
   year = {2017}
}

TY  - JOUR
ID  - 1395661
AU  - Kala, Petr - Novotný, Tomáš - Andršová, Irena - Benešová, Klára - Holická, Mária - Jarkovský, Jiří - Hnatkova, Katerina - Koc, Lumír - Mikolášková, Monika - Nováková, Tereza - Ondrúš, Tomáš - Přívarová, Lenka - Špinar, Jindřich - Malik, Marek
PY  - 2017
TI  - Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates
JF  - Plos one
VL  - 12
IS  - 3
SP  - 1-12
EP  - 1-12
PB  - Public Library of Science
SN  - 19326203
KW  - sub-acute phase of ST elevation myocardial infarction
N2  - Objective The introduction of primary percutaneous coronary intervention (PPCI) has modified the profile of ST elevation myocardial infarction (STEMI) patients. Occurrence and prognostic significance of hypotension episodes are not known in PPCI treated STEMI patients. It is also not known whether and/or how the hypotension episodes correlate with the degree of myocardial damage and whether there are any sex differences. Methods Data of 293 consecutive STEMI patients (189 males) treated by PPCI and without cardiogenic shock were analyzed. Blood pressure was measured noninvasively. A hypotensive episode was defined as a systolic blood pressure below 90 mmHg over a period of at least 30 minutes. Results A hypotensive episode was observed in 92 patients (31.4%). Female sex was the strongest independent predictor of hypotension episodes (p < 0.0001), while there was no relationship to electrocardiographic STEMI localization. Hypotensive patients had significantly higher levels of troponin T and brain natriuretic peptide; hypotensive episodes were particularly frequent in women with increased troponin T. Treatment with angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB) and betablockers was less frequent in hypotensive patients. After a mean 20-month follow-up, all-cause mortality did not differ between hypotensive patients and others. However, mortality in hypotensive patients who did not tolerate ACEI/ARB therapy was significantly higher compared to other hypotensive patients (p = 0.016). Conclusion Hypotension episodes are not uncommon in the sub-acute phase of contemporarily treated STEMI patients with a striking difference between sexes-female sex was the strongest independent predictor of hypotension episodes. Hypotensive episodes may lead to a delay in pharmacotherapy which influences prognosis. Higher incidence of hypotension in women could at least partially explain the sex-related differences in the use of cardiovascular pharmacotherapy which was repeatedly observed in various studies.
ER  -

KALA, Petr, Tomáš NOVOTNÝ, Irena ANDRŠOVÁ, Klára BENEŠOVÁ, Mária HOLICKÁ, Jiří JARKOVSKÝ, Katerina HNATKOVA, Lumír KOC, Monika MIKOLÁŠKOVÁ, Tereza NOVÁKOVÁ, Tomáš ONDRÚŠ, Lenka PŘÍVAROVÁ, Jindřich ŠPINAR and Marek MALIK. Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates. \textit{Plos one}. San Francisco: Public Library of Science, 2017, vol.~12, No~3, p.~1-12. ISSN~1932-6203. Available from: https://dx.doi.org/10.1371/journal.pone.0173699.

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