Neither Preoperative Pulse Pressure nor Systolic Blood Pressure Is Associated With Cardiac Complications After Coronary Artery Bypass Grafting
| Autor: | Edward G. Soltesz, Andrej Alfirevic, Chen Liang, Daniel Ramos, Andra E. Duncan, Kan Zhang |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Inotrope
Male medicine.medical_specialty Blood Pressure 03 medical and health sciences 0302 clinical medicine Postoperative Complications Troponin T 030202 anesthesiology Predictive Value of Tests Internal medicine medicine Humans Hospital Mortality Coronary Artery Bypass Aged Retrospective Studies business.industry Retrospective cohort study Perioperative Middle Aged Cardiac surgery Pulse pressure Anesthesiology and Pain Medicine Blood pressure medicine.anatomical_structure Treatment Outcome Heart Injuries Circulatory system Hypertension Preoperative Period Cardiology Female business 030217 neurology & neurosurgery Artery |
| Zdroj: | Anesthesia and analgesia. 131(5) |
| ISSN: | 1526-7598 |
| Popis: | BACKGROUND Increased pulse pressure has been associated with adverse cardiovascular events, cardiac and all-cause mortality in surgical and nonsurgical patients. Whether increased pulse pressure worsens myocardial injury and dysfunction after cardiac surgery, however, has not been fully characterized. We examined whether cardiac surgical patients with elevated pulse pressure are more susceptible to myocardial injury, dysfunction, cardiac-related complications, and mortality. Secondarily, we examined whether pulse pressure was a stronger predictor of the outcomes than systolic blood pressure. METHODS This retrospective observational study included adult cardiac surgical patients having elective isolated on-pump coronary artery bypass grafting (CABG) between 2010 and 2017 at the Cleveland Clinic. The association between elevated pulse pressure and (1) perioperative myocardial injury, measured by postoperative troponin-T concentrations, (2) perioperative myocardial dysfunction, assessed by the requirement for perioperative inotropic support using the modified inotropic score (MIS), and (3) cardiovascular complications assessed by the composite outcome of postoperative mechanical circulatory assistance or in-hospital mortality were assessed using multivariable linear regression models. Secondarily, the association between pulse pressure versus systolic blood pressure and the outcomes were compared. RESULTS Of 2704 patients who met the inclusion/exclusion criteria, complete data were available for 2003 patients. Increased pulse pressure over 40 mm Hg was associated with elevated postoperative troponin-T level, estimated to be 1.05 (97.5% confidence interval [CI], 1.02-1.09; P < .001) times higher per 10 mm Hg increase in pulse pressure. The association between pulse pressure and myocardial dysfunction and the composite outcome of cardiovascular complications and death were not significant. There was no difference in the association with pulse pressure versus systolic blood pressure and troponin-T concentrations. CONCLUSIONS Elevated preoperative pulse pressure was associated with a modest increase in postoperative troponin-T concentrations, but not postoperative cardiovascular complications or in-hospital mortality in patients having CABG. Pulse pressure was not a better predictor than systolic blood pressure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|