الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Recurrence of MI is common and carries a high mortality rate. The high pulse pressure represented an independent poor prognostic factor in the acute phase of myocardial infarction in the black African. The prognostic importance of SBP for various cardiovascular diseases is well established, and SBP is now regarded as a more important parameter than DBP. In CAD patients, decreased DBP has the possibility to increase cardiovascular risk due to lowering perfusion pressure of coronary circulation A cross section observational study design was used to evaluate the relationship between pp correlates to vessel stiffness and recurrent cardiovascular events in the survivors of a myocardial infarction and to assess the prognostic significance of PP on MI recurrence and on all-cause death. Our study was carried out on 70 patients with acute STEMI at the coronary care unit of Mansoura Specialized Hospital (MSH). Including, adult male or female with acute coronary syndrome (STEM) after a written consent ,with EF more than 50% and revascularized patients. Excluding, patients with known heart failure, previous MI, advanced renal or hepatic failure, or active cancer. The studied patients are classified according to their pulse pressure to three groups ; group with low pulse pressure (below 40 mmHg) including 22 cases, group with normal pulse pressure(40-60 mmHg) including 29 patients and group with high pulse pressure( >60 mmHg) including 19 patients. Each participant was subjected to detailed history taking: (name-age-gender-special habits-risk factors for ischemic heart diseases, smoking, diabetes, hypertension, hypercholesterolemia, positive family history, previous MI) plus to a history of peripheral vascular disease, stroke, and malignancy, and full clinical examination. Routine laboratory investigation was done (cardiac enzyme s [CK, CK-MB, Troponin], blood glucose, creatinine, liver enzymes). Electrocardiograph (ECG): for ST changes, ventricular enlargement, arrhythmias, and any sign of ischemia. Echocardiograph (ECHO): Left ventricular functions and EF will be measured. All Patients were followed up for one year by regular clinical examination, ECG and ECHO. All-cause mortality, cardiac mortality, and MACE events (non-fatal re-infarction, ischemic stroke and cardiac mortality) were recorded, then statistical analysis was done to assess the shape of the relationship between pulse pressure and major adverse outcomes and all cause mortality. Our study results revealed that the Mean age of the studied cases is 53.77 ,59.03 & 59.58 years, respectively for low , normal and high pulse pressure. the most common risk factor detected among studied cases was hypertension, followed by diabetes , smoking , dyslipidemia, obesity and positive family history. The mean ejection fraction on admission among studied cases was 52.91, 55.10 & 50.05% respectively for low, normal and high pulse pressure, and EF after following up was 55.39, 59.28 & 54.26 for low, normal and high pulse pressure respectively. The highest complications frequency is detected in cases with high pulse pressures; 6 cases developed recurrent MI (5 high pulse pressure , and 1 low pulse pressure), 3 cases develop stroke (all are with high pulse pressure), 4 cases have heart failure (3 cases with high PP and 1 case low PP) , 3 cases develop arrhythmia (all are with high PP )and 2 cases died (all are with high pulse pressure). The highest accuracy of pulse pressure in prediction of MACE was in detecting death (95%) followed by heart failure (82.8%), stroke (77.1%), arrhythmia (70%) and recurrence of myocardial infarction 60% Diabetes, hypertension, dyslipidaemia, obesity and increased pulse pressure were significant predictors of MACE among studied cases with increased risk of MACE (OR =4.21,1.21, 3.45, 3.87& 4.11 respectively).