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Neither Preoperative Pulse Pressure nor Systolic Blood Pressure Is Associated With Cardiac Complications After
Kan Zhang1, Andrej Alfirevic2, Daniel Ramos1
1From the Anesthesiology Institute.
Insights
Elevated preoperative pulse pressure modestly increased postoperative troponin-T levels in cardiac surgery patients. However, it did not worsen myocardial dysfunction, complications, or mortality, nor was it a better predictor than systolic blood pressure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Background:
- Increased pulse pressure is linked to adverse cardiovascular events and mortality in various patient groups.
- The specific impact of elevated pulse pressure on myocardial injury and dysfunction following cardiac surgery remains incompletely understood.
Purpose of the Study:
- To investigate if elevated pulse pressure increases myocardial injury, dysfunction, cardiac complications, and mortality in cardiac surgical patients.
- To compare pulse pressure with systolic blood pressure as predictors of these outcomes.
Main Methods:
- Retrospective observational study of adult patients undergoing elective isolated on-pump coronary artery bypass grafting (CABG) from 2010-2017.
- Multivariable regression models assessed associations between elevated pulse pressure and perioperative myocardial injury (troponin-T), myocardial dysfunction (inotropic support), and composite cardiovascular complications/mortality.
- Secondary analysis compared pulse pressure and systolic blood pressure as outcome predictors.
Main Results:
- A pulse pressure over 40 mm Hg was associated with a modest increase in postoperative troponin-T levels (1.05 times higher per 10 mm Hg increase).
- No significant association was found between pulse pressure and myocardial dysfunction or the composite outcome of cardiovascular complications and death.
- Pulse pressure was not a stronger predictor of troponin-T concentrations than systolic blood pressure.
Conclusions:
- Elevated preoperative pulse pressure is associated with a slight increase in postoperative troponin-T concentrations after CABG.
- Pulse pressure did not significantly predict postoperative cardiovascular complications or in-hospital mortality in this patient cohort.
- Pulse pressure demonstrated no advantage over systolic blood pressure in predicting myocardial injury markers.
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.
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