Clinical impact of proteinuria and blood pressure variability on long-term outcomes after percutaneous coronary intervention

Abstract

Proteinuria and blood pressure variability (BPV) are associated with adverse cardiovascular outcomes in coronary artery disease (CAD). However, their combined prognostic impact after percutaneous coronary intervention (PCI) is unknown. To investigate the association of proteinuria and BPV with long-term outcomes after PCI, we analyzed 2,539 patients from an observational PCI registry. Proteinuria was defined as ≥ 1 + on dipstick urinalysis at index hospitalization. BPV was calculated as the standard deviation of systolic blood pressure at follow-up visits and dichotomized at the median. The patients were categorized into four groups based on proteinuria and BPV. The primary endpoint was net adverse clinical events (NACE; all-cause death, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or major bleeding) over 5 years. During a median 5.64-year follow-up period, NACE occurred in 689 patients (27.1%). Both proteinuria and high BPV were independently associated with higher NACE risk. Concomitant proteinuria and high BPV had the highest risk of NACE (hazard ratio, 1.696; 95% confidence interval, 1.341–2.147 vs. no proteinuria and low BPV). The addition of proteinuria and BPV to conventional risk models significantly improved the risk discrimination and reclassification of NACE. Simple dipstick urinalysis and routine BPV assessment may provide complementary prognostic information in patients undergoing PCI.