Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association of wide pulse pressure with coronary collateral flow in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

Journal of Human Hypertension volume 39, pages 210–216 (2025)Cite this article

Subjects

Abstract

Coronary collateral flow (CCF) is crucial for myocardial viability in patients with obstructive coronary artery disease, specifically ST-elevation myocardial infarction (STEMI). However, hypertension can contribute to vascular dysfunction and hinder the formation of CCF. Wide pulse pressure (WPP), defined as ≥65 mmHg, may better reflect impaired cardiovascular health compared to classic blood pressure indices. The effect of WPP on CCF remains unclear. Therefore, we aimed to evaluate the impact of WPP on CCF. This retrospective study included 1180 STEMI patients that underwent primary percutaneous coronary intervention (PCI) between 2021 and 2023 at a tertiary healthcare center. Patients were classified into good and poor CCF groups based on the Rentrop classification. Out of these patients, 272 (23.1%) had good CCF, while 908 (76.9%) had poor CCF. Two distinct models were constructed using multivariable logistic regression analysis to identify independent predictors of good CCF, including pulse pressure (Model 1) and WPP (Model 2). Covariates such as age, gender, diabetes mellitus, smoking, pre-infarction angina, Killip Class 3/4, multivessel disease, peak troponin, pre-thrombolysis in myocardial infarction (TIMI) flow 0, and previous PCI were added to both models. WPP was identified as an independent predictor that negatively influences good CCF (OR: 0.511, 95% CI: 0.334–0.783, p = 0.002). Moreover, diabetes, pre-infarction angina, Killip class III/IV, multivessel disease, and pre-TIMI flow 0 were also found to be independent predictors of CCF. WPP, derived from blood pressure measurements, has been associated with poor CCF in STEMI patients undergoing primary PCI and may serve as a predictor of poor CCF.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Consort diagram of study population.
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data of the research is available in our University Hospital archive. A de-identified dataset will be shared with other researchers upon reasonable request from the corresponding author.

References

  1. Yoon SJ, Ko YG, Kim JS, Moon JY, Kim YJ, Park S, et al. Impact of coronary artery collaterals on infarct size assessed by serial cardiac magnetic resonance imaging after primary percutaneous coronary intervention in patients with acute myocardial infarction. Coron Artery Dis. 2009;20:440–5. https://doi.org/10.1097/MCA.0B013E328330C930.

    Article  PubMed  Google Scholar 

  2. Alsanjari O, Chouari T, Williams T, Myat A, Sambu N, Blows L. et al. Angiographically visible coronary artery collateral circulation improves prognosis in patients presenting with acute ST segment-elevation myocardial infarction. Catheter Cardiovasc Interv. 2020;96:528–33. https://doi.org/10.1002/CCD.28532.

    Article  PubMed  Google Scholar 

  3. Cui K, Lyu S, Song X, Yuan F, Xu F, Zhang M, et al. Effect of coronary collaterals on prognosis in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a meta-analysis. Angiology. 2018;69:803–11. https://doi.org/10.1177/0003319718768399.

    Article  PubMed  Google Scholar 

  4. Tang KS, Medeiros ED, Shah AD. Wide pulse pressure: a clinical review. J Clin Hypertens. 2020;22:1960–7. https://doi.org/10.1111/JCH.14051.

    Article  Google Scholar 

  5. Yang D, Chen J, Zhang T, Lin Y, Yao X, Meng L, et al. Influencing factors of wide pulse pressure in an elderly Chinese population: a cross-sectional study. J Clin Hypertens. 2022;24:1482–90. https://doi.org/10.1111/JCH.14582.

    Article  Google Scholar 

  6. Wang P, Li Y, Liu X, Wang Q, Guo Y, Zhao Y, et al. Independent and cumulative effects of resting heart rate and pulse pressure with type 2 diabetes mellitus in Chinese rural population. Sci Rep. 2017;7. https://doi.org/10.1038/S41598-017-02758-1.

  7. Okada K, Iso H, Cui R, Inoue M, Tsugane S. Pulse pressure is an independent risk factor for stroke among middle-aged Japanese with normal systolic blood pressure: the JPHC study. J Hypertens. 2011;29:319–24. https://doi.org/10.1097/HJH.0B013E32834143D9.

    Article  PubMed  CAS  Google Scholar 

  8. Geng TT, Talaei M, Jafar TH, Yuan JM, Koh WP. pulse pressure and the risk of end-stage renal disease among Chinese adults in Singapore: the Singapore Chinese health study. J Am Heart Assoc. 2019;8. https://doi.org/10.1161/JAHA.119.013282.

  9. Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study. Circulation. 1999;100:354–60. https://doi.org/10.1161/01.CIR.100.4.354.

    Article  PubMed  CAS  Google Scholar 

  10. Mancusi C, Losi MA, Izzo R, Canciello G, Carlino MV, Albano G, et al. Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: the Campania salute network. Eur J Prev Cardiol. 2018;25:235–43. https://doi.org/10.1177/2047487317747498.

    Article  PubMed  Google Scholar 

  11. Lorenzo C, Aung K, Stern MP, Haffner SM. Pulse pressure, prehypertension, and mortality: the San Antonio heart study. Am J Hypertens. 2009;22:1219–26. https://doi.org/10.1038/AJH.2009.151.

    Article  PubMed  Google Scholar 

  12. Peter Rentrop K, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985;5:587–92. https://doi.org/10.1016/S0735-1097(85)80380-6.

    Article  Google Scholar 

  13. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104. https://doi.org/10.1093/EURHEARTJ/EHY339.

    Article  PubMed  Google Scholar 

  14. Homan TD, Bordes SJ, Cichowski E. Physiology, Pulse Pressure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024 Jan [updated 2023 Jul 10]. https://www.ncbi.nlm.nih.gov/books/NBK482408/.

  15. DeMers D, Wachs D. Physiology, Mean Arterial Pressure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024 Jan [Updated 2023 Apr 10]. https://www.ncbi.nlm.nih.gov/books/NBK538226/

  16. Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023. https://doi.org/10.1097/HJH.0000000000003480.

  17. Benetos A, Rudnichi A, Safar M, Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension. 1998;32:560–4. https://doi.org/10.1161/01.HYP.32.3.560.

    Article  PubMed  CAS  Google Scholar 

  18. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81–S90. https://doi.org/10.2337/DC14-S081.

  19. François Mach, Colin Baigent, Alberico L Catapano, Konstantinos C Koskinas, Manuela Casula, Lina Badimon, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J. 2020;41:111–188. https://doi.org/10.1093/eurheartj/ehr158.

  20. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119–77. https://doi.org/10.1093/EURHEARTJ/EHX393.

    Article  PubMed  Google Scholar 

  21. Sotomi Y, Ueda Y, Hikoso S, Okada K, Dohi T, Kida H, et al. Pre-infarction angina: time interval to onset of myocardial infarction and comorbidity predictors. Front Cardiovasc Med. 2022;9. https://doi.org/10.3389/FCVM.2022.867723/FULL.

  22. Carmeliet P. Mechanisms of angiogenesis and arteriogenesis. Nat Med. 2000;6:389–95. https://doi.org/10.1038/74651.

    Article  PubMed  CAS  Google Scholar 

  23. Schaper W, Ito WD. Molecular mechanisms of coronary collateral vessel growth. Circ Res. 1996;79:911–9. https://doi.org/10.1161/01.RES.79.5.911.

    Article  PubMed  CAS  Google Scholar 

  24. Bigler MR, Seiler C. The human coronary collateral circulation, its extracardiac anastomoses and their therapeutic promotion. Int J Mol Sci. 2019;20. https://doi.org/10.3390/ijms20153726.

  25. Vural A, Kurt D, Karagöz A, Emecen Ö, Aydin E. The relationship between coronary collateral circulation and serum adropin levels. Cureus. 2023;15. https://doi.org/10.7759/CUREUS.35166.

  26. Koerselman J, de Jaegere PPT, Verhaar MC, van der Graaf Y, Grobee DE, Algra A, et al. High blood pressure is inversely related with the presence and extent of coronary collaterals. J Hum Hypertens. 2005;19:809–17. https://doi.org/10.1038/SJ.JHH.1001917.

    Article  PubMed  CAS  Google Scholar 

  27. Bakris GL, Laffin LJ. Assessing wide pulse pressure hypertension: data beyond the guidelines. J Am Coll Cardiol. 2019;73:2856–8. https://doi.org/10.1016/J.JACC.2019.03.494.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Vicaut E. Microcirculation and arterial hypertension. Drugs. 1999;58:1–10. https://doi.org/10.2165/00003495-199958991-00001.

  29. Boudier HA. Arteriolar and capillary remodelling in hypertension. Drugs. 1999;58:37–40.

  30. Boudier HA. Hypertension et microcirculation [Hypertension and microcirculation]. Arch Mal Coeur Vaiss. 2002;95:17–22.

  31. Nicolau JC, Pinto MAFV, Nogueira PR, Lorga AM, Jacob JLB, Garzon SAC. The role of antegrade and collateral flow in relation to left ventricular function post-thrombolysis. Int J Cardiol. 1997;61:47–54. https://doi.org/10.1016/S0167-5273(97)00134-4.

    Article  PubMed  CAS  Google Scholar 

  32. Kim EK, Choi JH, Song YBin, Hahn JY, Chang SA, Park SJ, et al. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction. Am Heart J. 2016;171:56–63. https://doi.org/10.1016/J.AHJ.2015.10.016.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Malazgirt State Hospital, Malazgirt, Muş, Turkey

    Cemalettin Yılmaz

  2. Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Istanbul, Kartal, Turkey

    Büşra Güvendi Şengör, Ahmet Karaduman, Barkın Kültürsay, Tuba Unkun & Regayip Zehir

  3. Department of Cardiology, Bulanık State Hospital, Bulanık, Muş, Turkey

    Muhammet Mücahit Tiryaki

Authors
  1. Cemalettin Yılmaz
    View author publications

    Search author on:PubMed Google Scholar

  2. Büşra Güvendi Şengör
    View author publications

    Search author on:PubMed Google Scholar

  3. Ahmet Karaduman
    View author publications

    Search author on:PubMed Google Scholar

  4. Muhammet Mücahit Tiryaki
    View author publications

    Search author on:PubMed Google Scholar

  5. Barkın Kültürsay
    View author publications

    Search author on:PubMed Google Scholar

  6. Tuba Unkun
    View author publications

    Search author on:PubMed Google Scholar

  7. Regayip Zehir
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Conceptualization and design: CY, BGŞ, AK. Data collection: AK, CY, BK, MMT. Data curation and analysis: BK, MMT, CY. Writing original draft: CY. Writing reviewing and editing; TU, RZ, CY, MMT, AK, BGŞ.

Corresponding author

Correspondence to Cemalettin Yılmaz.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study adhered to the principles of the Declaration of Helsinki and received ethical approval from the Kartal Kosuyolu Training and Research Hospital (Approval no: 2024/09/816).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yılmaz, C., Güvendi Şengör, B., Karaduman, A. et al. Association of wide pulse pressure with coronary collateral flow in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. J Hum Hypertens 39, 210–216 (2025). https://doi.org/10.1038/s41371-024-00986-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41371-024-00986-3

Search

Advanced search

Quick links