Pulse pressure is an age-independent predictor of stroke development after cardiac surgery
Alexandre Benjo1, Richard E Thompson, Derek Fine
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Insights
Vascular stiffness, measured by brachial pulse pressure, independently predicts stroke after cardiac surgery, outperforming age as a risk factor. Higher pulse pressure indicates increased stroke risk in patients.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Gerontology
Background:
- Chronologic age is a known risk factor for adverse outcomes post-cardiac surgery.
- However, age-related cardiovascular changes vary, suggesting limitations in using age alone for perioperative risk prediction.
- Vascular stiffness is an emerging indicator of vascular aging and may offer a more accurate predictive measure.
Purpose of the Study:
- To investigate the predictive value of vascular stiffness, assessed by brachial pulse pressure (PP), for stroke development after cardiac surgery.
- To compare the predictive accuracy of PP against traditional risk factors like age, gender, and diabetes.
- To determine if vascular stiffness indices can predict neurologic complications.
Main Methods:
- Retrospective review of 703 patients undergoing cardiac surgery.
- Measurement of brachial pulse pressure (PP) as an index of vascular stiffness.
- Utilized multivariable logistic regression and Cox proportional-hazard models to assess stroke probability and hazards.
- Kaplan-Meier analysis to evaluate stroke-free survival based on PP thresholds.
Main Results:
- Patients who experienced stroke had significantly higher brachial pulse pressure (81.2 mm Hg vs. 64.5 mm Hg).
- Brachial pulse pressure was an independent predictor of stroke in logistic and Cox models (OR 1.35, HR 1.32-2.62 per 10 mm Hg increase).
- Age, gender, and diabetes were not independent predictors; lower ejection fraction was inversely related to stroke.
Conclusions:
- Vascular stiffness, indicated by brachial pulse pressure, is a significant independent predictor of stroke after cardiac surgery.
- Pulse pressure may be a more accurate predictor of perioperative stroke risk than chronologic age.
- Indices of vascular stiffness show promise for predicting neurologic complications in this patient population.
Abstract:
Chronologic age is a strong predictor of adverse outcomes after cardiac surgery. The variability in age-related cardiovascular changes suggests that age may not be the most accurate predictor of adverse perioperative outcomes. Vascular stiffness has emerged as an important surrogate of vascular aging. In a retrospective review, we investigated the value of vascular stiffness, as assessed by brachial pulse pressure (PP) measurements, in predicting stroke in 703 patients (63.4% men and 36.6% women). Patients were followed for 348+/-215 days after cardiac surgery. We used a multivariable logistic model and unadjusted and adjusted Cox proportional-hazard models to assess the probability of stroke and the hazards of stroke over time. Stroke patients had a significantly higher PP (81.2 mm Hg versus 64.5 mm Hg; P=0.0006). In the logistic regression model, PP was an independent predictor of stroke development (unadjusted odds ratio: 1.35; 95% CI: 1.13 to 1.62, for every 10-mm Hg increase in PP; P=0.001). In the unadjusted and adjusted Cox models, PP again predicted stroke (hazard ratio: 1.32; 95% CI: 1.12 to 1.57; hazard ratio: 2.62; 95% CI: 1.49 to 4.60, respectively; P=0.001 for both) for every 10 mm Hg increase in PP. Age, gender, and diabetes were not independent predictors of stroke. Ejection fraction was inversely related to stroke in the adjusted model. Kaplan-Meier estimates and corresponding log-rank test indicated that the probability of stroke-free survival function was significantly lower (P=0.0067) in patients with PP >72 mm Hg versus <72 mm Hg. This analysis suggests that indices of vascular stiffness could be important predictors of neurologic complications.
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