{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:27:56Z","timestamp":1782458876391,"version":"3.54.5"},"reference-count":24,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T00:00:00Z","timestamp":1699056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Although the clinical outcomes for patients with ST-elevation myocardial infarction (STEMI) have improved significantly, some patients still experience poor clinical outcomes. The available risk classifications focus on the short-term outcomes, and it remains important to find high-risk features among patients with STEMI. In Japan, the 200 m walk electrocardiogram (ECG) test is widely performed before discharge. The purpose of this study was to investigate the association between the excessive increase in systolic blood pressure (SBP) following a 200 m walk and the long-term clinical outcomes in patients with STEMI. Methods: We included 680 patients with STEMI and divided those into an excessive increase in SBP group (n = 144) and a non-excessive increase in SBP group (n = 536) according to the SBP increase after a 200 m walk ECG test. We defined an excessive increase in SBP as SBP \u2265 20 mmHg either just after or 3 min after a 200 m walk ECG test. The primary endpoint consisted of major cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization. Results: The median follow-up duration was 831 days. MACE was more frequently observed in the excessive increase in SBP group (24.3%) than in the non-excessive increase in SBP group (15.1%). Multivariate Cox hazard analysis revealed that the excessive increase in SBP was significantly associated with MACE (HR 1.509, 95% CI: 1.005\u20132.267, p = 0.047) after controlling for multiple confounding factors. Conclusion: An excessive increase in SBP after the 200 m walk ECG test was significantly associated with MACE in patients with STEMI. The 200 m walk ECG test is simple and low-cost, but may help to identify high-risk patients with STEMI.<\/jats:p>","DOI":"10.3390\/jcm12216928","type":"journal-article","created":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T15:41:41Z","timestamp":1699112501000},"page":"6928","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction"],"prefix":"10.3390","volume":"12","author":[{"given":"Takahiro","family":"Yamashita","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3566-0394","authenticated-orcid":false,"given":"Kenichi","family":"Sakakura","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Jinnouchi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousuke","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takunori","family":"Tsukui","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Hatori","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Tamanaha","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9995-2615","authenticated-orcid":false,"given":"Taku","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaru","family":"Seguchi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Fujita","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City 330-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S0140-6736(03)12113-7","article-title":"Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials","volume":"361","author":"Keeley","year":"2003","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"887","DOI":"10.7326\/0003-4819-108-6-887","article-title":"The Coronary Care Unit Turns 25: Historical Trends and Future Directions","volume":"108","author":"Lee","year":"1988","journal-title":"Ann. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/j.amjcard.2017.01.007","article-title":"Outcomes After Percutaneous Coronary Intervention of Acute Coronary Syndrome Complicated with Cardiopulmonary Arrest (from a Japanese Multicenter Registry)","volume":"119","author":"Numasawa","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1161\/01.CIR.102.17.2031","article-title":"TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy","volume":"102","author":"Morrow","year":"2000","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.amjcard.2005.09.131","article-title":"Prediction of One-Year Mortality Among 30-Day Survivors After Primary Percutaneous Coronary Interventions","volume":"97","author":"Mehta","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1001\/archinte.163.19.2345","article-title":"Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events","volume":"163","author":"Granger","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1253\/circj.CJ-19-0133","article-title":"JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome","volume":"83","author":"Kimura","year":"2019","journal-title":"Circ. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1016\/j.jacc.2013.02.020","article-title":"Association Between Gait Speed as a Measure of Frailty and Risk of Cardiovascular Events After Myocardial Infarction","volume":"61","author":"Matsuzawa","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00380-020-01667-0","article-title":"Usefulness of 500-m walk electrocardiogram test on clinical outcomes in patients with ST-segment elevation myocardial infarction","volume":"36","author":"Ohashi","year":"2021","journal-title":"Heart Vessels"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1016\/j.jacc.2018.08.1038","article-title":"Fourth Universal Definition of Myocardial Infarction (2018)","volume":"72","author":"Thygesen","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s00380-022-02200-1","article-title":"Factors associated with intensive care unit delirium in patients with acute myocardial infarction","volume":"38","author":"Sakakura","year":"2023","journal-title":"Heart Vessels"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s00380-022-02145-5","article-title":"Comparison of in-hospital outcomes of acute myocardial infarction between patients with cardiogenic shock and with cardiac arrest","volume":"38","author":"Kasahara","year":"2022","journal-title":"Heart Vessels"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s12928-021-00778-3","article-title":"Comparison of the cost in percutaneous coronary intervention between ST-segment elevation myocardial infarction vs. non-ST-segment elevation myocardial infarction","volume":"37","author":"Murakami","year":"2022","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_14","first-page":"163","article-title":"Factors associated with aorto-ostial stent coverage during intravascular ultrasound-guided percutaneous coronary intervention to severely narrowed non-ostial right coronary artery lesions","volume":"17","author":"Narita","year":"2021","journal-title":"Adv. Interv. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1007\/s00380-019-01366-5","article-title":"Comparison of mid-term clinical outcomes after acute myocardial infarction in diabetic men between living alone and living together","volume":"34","author":"Otani","year":"2019","journal-title":"Heart Vessels"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"992","DOI":"10.5551\/jat.62998","article-title":"Association of Asymptomatic Low Ankle\u2013Brachial Index with Long-Term Clinical Outcomes in Patients after Acute Myocardial Infarction","volume":"29","author":"Ban","year":"2022","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1053\/j.ajkd.2008.12.034","article-title":"Revised Equations for Estimated GFR From Serum Creatinine in Japan","volume":"53","author":"Matsuo","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/S0002-8703(05)80015-8","article-title":"Prognostic value of abnormal postexercise systolic blood pressure response: Prehospital discharge test after myocardial infarction in Japan","volume":"119","author":"Kato","year":"1990","journal-title":"Am. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.amjcard.2008.04.027","article-title":"Usefulness of Paradoxical Systolic Blood Pressure Increase After Exercise as a Predictor of Cardiovascular Mortality","volume":"102","author":"Huang","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/0735-1097(93)90173-X","article-title":"Abnormal systolic blood pressure response during exercise recovery in patients with angina pectoris","volume":"22","author":"Hashimoto","year":"1993","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/HJH.0b013e32834f41b1","article-title":"The relationship between arterial stiffness and increase in blood pressure during exercise in normotensive persons","volume":"30","author":"Sung","year":"2012","journal-title":"J. Hypertens."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.atherosclerosis.2011.09.013","article-title":"The association between cerebral atherosclerosis and arterial stiffness in acute ischemic stroke","volume":"219","author":"Kim","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1161\/01.CIR.0000017186.52382.F4","article-title":"Four faces of baroreflex failure: Hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia","volume":"105","author":"Ketch","year":"2002","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1093\/ajh\/hpv022","article-title":"Orthostatic Changes in Blood Pressure and Mortality in the Elderly: The Pro.V.A Study","volume":"28","author":"Veronese","year":"2015","journal-title":"Am. J. 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