Baseline Characteristics
A total of 4114 patients were included in this study. The mean age was 64.9 ± 12.5 years and 28% were female. The overall mean follow-up duration was 33.2 ± 8.6 months (3–84 months).
Group A of LVEF < 50% were divided into four SBP groups. Patients in the lowest admission SBP group (SBP 90–99 mmHg) had a significantly higher proportion of STEMI, higher white blood cell count, CRP, CK - MB peak, TNI peak levels (all P < 0.01) than the other 3 SBP groups. These results suggested that the degree of myocardial necrosis could be high in patients with the lowest SBP group, and the inflammatory response caused by myocardial infarction was more intense in the acute stage. Patients in the highest admission SBP group (SBP ≥ 140mmHg) more likely had a history of hypertension, diabetes, and had higher NT-proBNP level at admission (P < 0.05) (Table 1). Increased pressure in the left atria and ventricular walls stimulated BNP secretion [11]. In this group of LVEF < 50%, NT-proBNP levels increased as BP increased, suggesting that in addition to heart failure factors, the increase in ventricular wall pressure caused by elevated blood pressure might also be a cause.
Table 1
Baseline Characteristics of Patients
|
|
GroupA EF < 50% n = 812
|
|
|
|
|
Group B
EF ≥ 50% n = 3302
|
|
|
|
1 group
SBP90-99
mmHg
n = 98
|
2 group
SBP100-119
mmHg
n = 235
|
3 group
SBP120-139
mmHg
n = 268
|
4 group
SBP ≥ 140mmHg
n = 211
|
P value
|
1 group
SBP90-99
mmHg
n = 215
|
2 group
SBP100-119
mmHg
n = 848
|
3 group
SBP120-139
mmHg
n = 1161
|
4 group
SBP ≥ 140mmHg
n = 1078
|
P value
|
Age,years
|
66.5 ± 12.5
|
67.7 ± 11.8
|
68.3 ± 12.3
|
70.1 ± 10.9
|
0.061
|
62.6 ± 11.6
|
62.4 ± 10.7
|
63.8 ± 12.1
|
65.7 ± 11.4
|
0.001
|
Male gender
|
75(76.5)
|
179(76.2)
|
195(72.8)
|
151(71.6)
|
0.624
|
160(74.4)
|
647(76.3)
|
862(74.2)
|
739(68.6)
|
0.001
|
BMI, kg/m2
|
24.3 ± 4.2
|
24.4 ± 4.1
|
25.0 ± 5.0
|
25.2 ± 4.3
|
0.057
|
25.3 ± 4.3
|
25.1 ± 4.6
|
25.6 ± 4.9
|
25.9 ± 5.0
|
0.001
|
SBP,mmHg
|
94 ± 3.6
|
110 ± 2.8
|
128 ± 3.7
|
153 ± 5.8
|
< 0.001
|
95 ± 3.8
|
110 ± 3.5
|
128 ± 3.9
|
154 ± 7.3
|
< 0.001
|
DBP,mmHg
|
62 ± 2.7
|
68 ± 4.8
|
75 ± 4.2
|
83 ± 5.2
|
< 0.001
|
63 ± 2.6
|
66 ± 4.6
|
73 ± 5.1
|
82 ± 5.4
|
< 0.001
|
Medical history
|
|
|
|
|
|
|
|
|
|
|
Current/ex-Smoker
|
40(40.8)
|
102(43.4)
|
103(38.4)
|
78(37.0)
|
0.526
|
114(53.0)
|
443(52.2)
|
551(47.5)
|
413(38.3)
|
< 0.001
|
HT
|
46(46.9)
|
132(56.2)
|
184(68.7)
|
169(80.1)
|
< 0.001
|
93(43.3)
|
433(51.1)
|
751(64.7)
|
862(80.0)
|
< 0.001
|
DM
|
26(26.5)
|
99(42.1)
|
103(38.4)
|
92(43.6)
|
0.027
|
51(23.7)
|
244(28.8)
|
366(31.5)
|
371(34.4)
|
0.004
|
Dyslipidemia
|
47(48.0)
|
95(40.4)
|
114(42.5)
|
87(41.2)
|
0.631
|
97(45.1)
|
373(44.0)
|
525(45.2)
|
479(44.4)
|
0.952
|
stroke
|
21(21.5)
|
47(20.0)
|
53(19.8)
|
48(22.7)
|
0.856
|
24(11.2)
|
104(12.3)
|
176(15.2)
|
211(19.6)
|
< 0.001
|
CHD
|
33(33.7)
|
84(35.7)
|
107(39.9)
|
88(41.7)
|
0.413
|
46(21.4)
|
197(23.2)
|
319(27.5)
|
319(29.6)
|
0.004
|
OMI
|
19(19.4)
|
50(21.3)
|
44(16.4)
|
44(20.9)
|
0.504
|
16(7.4)
|
76(9.0)
|
136(11.7)
|
99(9.2)
|
0.066
|
Past PCI
|
15(15.3)
|
35(14.9)
|
29(10.8)
|
31(14.7)
|
0.465
|
18(8.4)
|
76(9.0)
|
135(11.6)
|
100(9.3)
|
0.100
|
HF
|
4(4.1)
|
5(2.1)
|
8(3.0)
|
3(1.4)
|
0.487
|
1(0.5)
|
6(0.7)
|
6(0.5)
|
8(0.7)
|
0.857
|
Family history of CHD
|
25(25.5)
|
76(32.3)
|
66(24.6)
|
48(22.7)
|
0.103
|
67(31.2)
|
274(32.3)
|
365(31.4)
|
288(26.7)
|
0.030
|
Antiplatelet agent
|
34(34.7)
|
73(45.1)
|
89(33.2)
|
74(35.1)
|
0.082
|
51(23.7)
|
208(24.5)
|
333(28.7)
|
305(27.2)
|
0.097
|
Initial diagnosis
|
|
|
|
|
|
|
|
|
|
|
STEMI
|
76(77.6)
|
159(67.7)
|
143(53.4)
|
93(44.1)
|
< 0.001
|
149(69.4)
|
459(54.1)
|
540(46.5)
|
404(37.5)
|
0.000
|
Laboratory values
|
|
|
|
|
|
|
|
|
|
|
WBC,109/L
|
10.55 ± 2.2
|
9.02 ± 2.5
|
8.26 ± 3.2
|
8.26 ± 2.9
|
< 0.001
|
9.91 ± 2.5
|
8.81 ± 2.1
|
8.25 ± 2.6
|
8.08 ± 2.4
|
< 0.001
|
CRP,mg/L
|
39.30 ± 15.6
|
21.40 ± 11.8
|
19.26 ± 13.7
|
22.97 ± 14.9
|
0.001
|
12.12 ± 8.5
|
15.22 ± 9.7
|
14.92 ± 8.9
|
12.35 ± 9.1
|
0.553
|
eGFR, ml/min/1.73m2
|
73.92 ± 26.8
|
83.39 ± 24.7
|
80.80 ± 27.2
|
76.42 ± 28.4
|
0.491
|
88.53 ± 28.9
|
91.63 ± 27.6
|
88.95 ± 25.3
|
78.87 ± 27.9
|
< 0.001
|
HbA1c, %
|
6.60 ± 2.5
|
6.72 ± 3.0
|
6.79 ± 3.2
|
6.69 ± 3.5
|
0.772
|
6.39 ± 2.7
|
6.42 ± 3.2
|
6.51 ± 3.5
|
6.62 ± 3.8
|
0.026
|
TC,mmol/L
|
4.26 ± 1.4
|
4.23 ± 1.5
|
4.31 ± 1.3
|
4.41 ± 1.7
|
0.332
|
4.33 ± 1.5
|
4.43 ± 1.8
|
4.46 ± 1.7
|
4.50 ± 1.6
|
0.144
|
TG,mmol/L
|
1.32 ± 0.5
|
1.39 ± 0.7
|
1.43 ± 0.9
|
1.53 ± 0.8
|
0.199
|
1.70 ± 0.6
|
1.73 ± 0.8
|
1.77 ± 0.9
|
1.84 ± 0.7
|
0.272
|
HDL-C,mmol/L
|
1.06 ± 0.6
|
1.04 ± 0.4
|
1.03 ± 0.7
|
1.05 ± 0.6
|
0.791
|
1.02 ± 0.5
|
1.03 ± 0.8
|
1.05 ± 0.6
|
1.06 ± 0.7
|
0.112
|
LDL-C,mmol/L
|
2.48 ± 1.3
|
2.45 ± 1.6
|
2.51 ± 1.5
|
2.58 ± 1.8
|
0.399
|
2.52 ± 1.4
|
2.58 ± 1.7
|
2.59 ± 1.6
|
2.62 ± 1.8
|
0.377
|
NT-pro BNP
|
6848 ± 1458
|
6502 ± 1386
|
7401 ± 1478
|
8361 ± 1502
|
0.027
|
2019 ± 723
|
1701 ± 689
|
1976 ± 704
|
2747 ± 653
|
0.000
|
pNT-pro BNP
|
11577 ± 2358
|
10291 ± 2147
|
10113 ± 1988
|
11083 ± 2096
|
0.539
|
4387 ± 1058
|
3137 ± 984
|
3107 ± 987
|
3958 ± 1023
|
< 0.001
|
pCK-MB,ng/ml
|
190 ± 52
|
147 ± 49
|
119 ± 42
|
93 ± 39
|
< 0.001
|
196 ± 47
|
116 ± 37
|
89 ± 36
|
81 ± 40
|
< 0.001
|
pTNI,ng/ml
|
24.91 ± 11.2
|
18.45 ± 9.4
|
12.91 ± 9.1
|
11.82 ± 8.9
|
< 0.001
|
22.07 ± 10.8
|
12.58 ± 9.3
|
9.35 ± 9.5
|
9.89 ± 8.7
|
< 0.001
|
Echocardiography
|
|
|
|
|
|
|
|
|
|
|
LA,cm
|
3.90 ± 1.6
|
3.99 ± 1.5
|
4.07 ± 1.7
|
4.09 ± 1.8
|
0.027
|
3.71 ± 1.4
|
3.66 ± 1.6
|
3.73 ± 1.5
|
3.79 ± 1.7
|
0.002
|
LVEDD,cm
|
5.64 ± 2.0
|
5.87 ± 1.9
|
5.91 ± 2.1
|
5.89 ± 2.2
|
0.008
|
5.04 ± 1.8
|
5.06 ± 2.0
|
5.09 ± 1.9
|
5.11 ± 2.1
|
0.049
|
EF
|
0.42 ± 0.13
|
0.40 ± 0.16
|
0.40 ± 0.15
|
0.41 ± 0.16
|
0.395
|
0.60 ± 0.18
|
0.61 ± 0.19
|
0.62 ± 0.20
|
0.62 ± 0.17
|
0.360
|
In-hospital treatment
|
|
|
|
|
|
|
|
|
|
|
PCI
|
68(69.4)
|
158(67.2)
|
173(64.6)
|
127(60.2)
|
0.322
|
185(86.0)
|
684(80.7)
|
919(79.2)
|
796(73.8)
|
< 0.001
|
Data are presented as mean ± SD or n (%). 1 group: SBP 90-99mmHg, 2 group: SBP 100-119mmHg, 3 group: SBP 120-139mmHg, 4 group: SBP ≥ 140mmHg. |
BMI body mass index, SBP systolic blood pressure, DBP diastolic blood pressure, HT hypertension, DM diabetes mellitus, CHD coronary heart disease, OMI old myocardial infarction, PCI percutaneous coronary intervention, HF heart failure, WBC white blood cell, CRP c-reactive protein, Cr creatinine, eGFR estimated glomerular filtration rate, HbA1c glycosylated hemoglobin, TC total cholesterol, TG triglycerides; LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol, pNT-proBNP, the peak value of N-terminal pro-brain natriuretic peptide, pCK-MB, the peak value of creatine kinase MB, pTNI, the peak value of troponin I, LA left atrium, EDD, LVEDD left ventricular end-diastolic diameter, EF ejection fraction. |
Group B of LVEF ≥ 50% were also divided into four groups of SBP. Patients in the lowest admission SBP group (SBP 90–99 mmHg) were younger, more often male, and more smokers, had lower body mass index, and had a higher proportion of STEMI, higher white blood cell count, CK - MB peak, and TNI peak levels (P < 0.05). Patients in the highest admission SBP group (SBP ≥ 140mmHg) more likely had a history of coronary heart disease, hypertension, diabetes, and had higher NT-proBNP level at admission (all P < 0.05) (Table 1). These data suggested that hypertension patients appear more likely to be complicated with diabetes, coronary heart disease and stroke, which is consistent with previous clinical studies.
We further compared the baseline characteristics between group A and group B (Fig. 2). LVEF value in different SBP groups were significantly higher in group B than group A (P < 0.05, Fig. 2A). In all groups, as SBP increased, the proportion of STEMI patients decreased gradually (Fig. 2B). Similar results were observed for TNI and CK-MB peak levels (Fig. 2C, Fig. 2D). TNI and CK-MB are biomarkers of myocardial necrosis. As SBP increases, the peak levels of TNI and CK-MB in patients gradually decreased, suggesting that the low SBP in patients with AMI, whether accompanied by heart failure, may be related to the extensive area and severity of myocardial necrosis. Compared with group B, the levels of NT-proBNP in different admission SBP groups in group A were significantly higher (P < 0.05, Fig. 2E), which is consistent with the poor left ventricular function of the patient in Group A of LVEF < 50%. The level of CRP at admission in group A was higher than that in group B, especially for the group with the lowest SBP (P < 0.05, Fig. 2F), suggesting that the level of inflammatory response in patients with AMI complicated with heart failure might be high.
Blood pressure outcome associations
For group A of LVEF < 50%, in the lowest SBP group (SBP 90-99mmHg), the incidence of cardiovascular death was 14.3%, and the incidence of major adverse cardiac and cerebral events (MACCEs) during hospitalization was 19.45% (including all-cause death, non-fatal MI, malignant arrhythmia, acute stent thrombosis and stroke), and both of these incidence rates were significantly higher than those in the other systolic blood pressure groups (P = 0.001, Table 2). However, long-term follow-up results of the patients in this group have shown that there was no significant difference in the incidence of cardiovascular death and all-cause death among the 4 systolic blood pressure groups (P > 0.05, Table 2).
Table 2
In-hospital and Follow-up Outcomes of Patients
|
|
Group A
EF < 50%
n = 812
|
|
|
|
|
Group B
EF ≥ 50%
n = 3302
|
|
|
|
1 group
n = 98
|
2 group
n = 235
|
3 group
n = 268
|
4 group
n = 211
|
P value
|
1 group
n = 215
|
2 group
n = 848
|
3 group
n = 1161
|
4 group
n = 1078
|
P value
|
In-hospital outcomes
|
|
|
|
|
|
|
|
|
|
|
Composite MACCEs
|
19(19.5)
|
33(14.0)
|
18(6.7)
|
16(7.6)
|
0.001
|
14(6.5)
|
43(5.1)
|
53(4.6)
|
34(3.2)
|
0.051
|
CV death
|
14(14.3)
|
24(10.2)
|
12(4.5)
|
9(4.3)
|
0.001
|
5(2.3)
|
13(1.5)
|
18(1.6)
|
12(1.1)
|
0.547
|
Follow-up outcomes
|
|
|
|
|
|
|
|
|
|
|
All-cause death
|
29(29.6)
|
61(26.0)
|
67(25.0)
|
63(29.9)
|
0.599
|
20(9.3)
|
67(7.9)
|
106(9.1)
|
134(12.4)
|
0.006
|
CV death
|
27(27.6)
|
58(24.7)
|
61(22.8)
|
49(23.2)
|
0.793
|
16(7.4)
|
52(6.1)
|
80(6.9)
|
106(9.8)
|
0.012
|
Values are presented as number (%). Composite MACCEs include: all- cause death, non-fatal MI, malignant arrhythmia, acute stent thrombosis and stroke. MACCEs major adverse cardiac and cerebral events, MI myocardial infarction, CV cardiovascular. 1 group: SBP 90-99mmHg, 2 group: SBP 100-119mmHg, 3 group: SBP 120-139mmHg, 4 group: SBP ≥ 140mmHg. |
For group B of LVEF ≥ 50%, there was no significant difference in the incidence of either cardiovascular death or MACCEs during hospitalization in the 4 different SBP groups (P > 0.05, Table 2). Patients in the highest group of admission SBP (SBP ≥ 140mmHg) had significantly higher rates of cardiovascular death (9.8%) and all-cause death (12.4%) than patients in other SBP groups during long-term follow-up (P < 0.05, Table 2).
Compared with patients with LVEF ≥ 50%, patients with LVEF < 50% had significantly increased cardiogenic mortality during hospitalization and during long-term follow-up (Fig. 3). Especially in the LVEF < 50% group, the incidence of MACCEs and cardiovascular death during hospitalization was significantly increased in patients with SBP < 120mmHg (P < 0.05, Fig. 3A 3B). These results indicate that patients with AMI complicated with heart failure and with admission SBP lower than 120mmHg could have poor short-term outcome. The long-term follow-up results have shown that in all four groups, patients with AMI in the LVEF < 50% group had poor long-term outcome than patients with normal cardiac function (P < 0.05, Fig. 3C 3D).
Patients of LVEF < 50% in the lowest SBP group (SBP 90-99mmHg) had higher incidence of cardiovascular death and MACCEs during hospitalization than the other 3 SBP groups. Patients in the lowest levels of SBP (SBP 90-99mmHg, reference category) had significantly higher rates of cardiovascular death compared to patients with SBP 120–139 mmHg [adjusted odds ratio (OR) 0.287, 95% confidence interval (CI) 0.1110–0.748]and patients with SBP ≥ 140 mmHg [adjusted OR 0.241, 95% CI 0.089–0.651]. Compared with SBP 90-99mmHg patients, the risk of cardiovascular death in SBP 100–119 mmHg group showed a trend of reduction (adjusted OR = 0.801, 95%CI 0.347–1.847, P = 0.602), and consistent findings were also observed for major adverse cardiac and cerebral events in the SBP 100–119 mmHg group (Table 3). Multivariable logistic regression analysis indicated that three clinical factors including age, renal function and heart failure are closely related with cardiovascular death (p < 0.05, Table 3). In addition, age, heart failure and previous myocardial infarction were associated with composite MACCEs during hospitalization.
Table 3
Multivariable Logistic regression analysis of Cardiovascular death and MACCEs in hospital (group A)
SBP groups
|
Crude OR
(95% CI)
|
P-value
|
Adjusted ORa
(95% CI)
|
P-value
|
Cardiovascular death
|
|
|
|
|
90-99mmHg
|
1
|
-
|
1
|
-
|
100-119mmHg
|
0.682(0.337–1.383)
|
0.289
|
0.801(0.347–1.847)
|
0.602
|
120-139mmHg
|
0.281(0.125–0.632)
|
0.002
|
0.287(0.110–0.748)
|
0.011
|
≥ 140mmHg
|
0.267(0.111–0.641)
|
0.003
|
0.241(0.089–0.651)
|
0.005
|
Age
|
1.065(1.037–1.093)
|
0.000
|
1.056(1.024–1.089)
|
0.001
|
BMI
|
0.928(0.863–0.997)
|
0.042
|
-
|
0.421
|
EGFR
|
0.979(0.970–0.989)
|
0.000
|
0.982(0.970–0.994)
|
0.004
|
smoking
|
0.404(0.215–0.760)
|
0.005
|
-
|
0.351
|
hypertension
|
1.334(0.745–2.389)
|
0.333
|
|
|
diabetes
|
1.426(0.838–2.427)
|
0.191
|
|
|
heart failure
|
7.663(2.931–20.031)
|
0.000
|
6.713(1.965–22.931)
|
0.002
|
previous myocardial infarction
|
1.195(0.629–2.271)
|
0.586
|
|
|
previous stroke
|
1.909(1.075–3.392)
|
0.027
|
-
|
0.106
|
peripheral artery disease
|
2.022(0.871–4.696)
|
0.101
|
|
|
the peak value of TnI
|
1.008(0.994–1.023)
|
0.265
|
|
|
Composite MACCEs
|
|
|
|
|
90-99mmHg
|
1
|
-
|
1
|
-
|
100-119mmHg
|
0.679(0.365–1.265)
|
0.223
|
0.765(0.389–1.506)
|
0.439
|
120-139mmHg
|
0.299(0.150–0.598)
|
0.001
|
0.323(0.152–0.685)
|
0.003
|
≥ 140mmHg
|
0.341(0.167–0.697)
|
0.003
|
0.342(0.158-0741)
|
0.007
|
Age
|
1.038 (1.017–1.059)
|
0.000
|
1.043 (1.021–1.066)
|
0.000
|
BMI
|
0.962 (0.906–1.021)
|
0.205
|
|
|
EGFR
|
0.989 (0.981–0.997)
|
0.006
|
-
|
0.084
|
smoking
|
0.626 (0.386–1.015)
|
0.057
|
|
|
hypertension
|
1.249 (0.769–2.029)
|
0.368
|
|
|
diabetes
|
1.062 (0.674–1.674)
|
0.796
|
|
|
heart failure
|
4.860 (1.884–12.538)
|
0.001
|
3.284 (1.111–9.711)
|
0.032
|
previous myocardial infarction
|
2.527 (1.559–4.096)
|
0.000
|
2.314 (1.381–3.878)
|
0.001
|
previous stroke
|
1.450 (0.870–2.417)
|
0.154
|
|
|
peripheral artery disease
|
1.516 (0.691–3.329)
|
0.300
|
|
|
the peak value of TnI
|
1.004 (0.992–1.017)
|
0.487
|
|
|
a Models adjusted for age, body mass index, estimated glomerular filtration rate, smoking status, history of hypertension, diabetes, heart failure history, previous myocardial infarction, previous stroke, peripheral artery disease, the peak value of troponin I. |
MACCEs major adverse cardiac and cerebral events, MI myocardial infarction, CV cardiovascular. group A: EF<50% |
The patients of LVEF ≥ 50% in the highest SBP group (SBP ≥ 140mmHg) were at significantly higher risk of cardiovascular death during long-term follow-up. Patients in the highest levels of SBP (SBP ≥ 140 mmHg, reference category) presented a significantly increased risk of cardiovascular death [adjusted hazard ratio (HR) 0.753, 95% CI: 0.530–0.871 for SBP 100–119 mmHg, HR 0.765, 95% CI: 0.567–0.933 for SBP 120–139 mmHg, and HR 0.519, 95% CI: 0.236–0.840 for SBP 90–99 mmHg] (Table 4). And renal function, smoking history, history of hypertension and heart failure, the usage of beta blocker were associated with cardiovascular death in the following up period (Table 4). The survival curve showing the effect of different SBP on mortality adjusted to other prognostic factors is presented in Fig. 4.
Table 4
Multivariable Cox regression analysis of Cardiovascular death in follow up (group B)
SBP groups
|
Crude OR
(95% CI)
|
P-value
|
Adjusted ORa
(95% CI)
|
P-value
|
Cardiovascular death
|
|
|
|
|
90-99mmHg
|
0.501(0.244–1.028)
|
0.054
|
0.519(0.236–0.840)
|
0.018
|
100-119mmHg
|
0.614(0.440–0.855)
|
0.000
|
0.753(0.530–0.871)
|
0.000
|
120-139mmHg
|
0.680(0.509–0.909)
|
0.009
|
0.765(0.567–0.933)
|
0.020
|
≥ 140mmHg
|
1
|
-
|
1
|
-
|
BMI
|
0.855(0.823–1.029)
|
0.09
|
0.930(0.917–1.182)
|
0.07
|
EGFR
|
0.972(0.967–0.976)
|
0.000
|
0.986(0.980–0.992)
|
0.000
|
smoking
|
0.593(0.455–0.771)
|
0.000
|
1.557(1.158–2.095)
|
0.02
|
hypertension
|
2.060(1.520–2.791)
|
0.000
|
1.532(1.096–2.141)
|
0.01
|
diabetes
|
1.478(1.145–1.909)
|
0.000
|
1.177(0.898–1.542)
|
0.432
|
heart failure
|
10.668(5.247–21.693)
|
0.000
|
3.649(1.746–7.624)
|
0.000
|
previous myocardial infarction
|
1.139(0.747–1.736)
|
0.683
|
|
|
previous stroke
|
1.693(1.256–2.281)
|
0.009
|
1.069(0.787–1.451)
|
0.490
|
peripheral artery disease
|
1.549(0.946–2.536)
|
0.176
|
|
|
the peak value of TnI
|
0.989(0.978-1.000)
|
0.212
|
|
|
ACEI/ARB
|
0.510(0.396–0.656)
|
0.010
|
0.535(0.408–1.102)
|
0.12
|
beta-blocker
|
0.509(0.394–0.658)
|
0.000
|
0.670(0.514–0.873)
|
0.002
|
aModels adjusted forbody mass index, estimated glomerular filtration rate, smoking status, history of hypertension, diabetes, heart failure history, previous myocardial infarction, previous stroke, peripheral artery disease, the peak value of troponin I, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers. |
group B: EF ≥ 50% |