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Day-to-day blood pressure variability predicts poor outcomes following percutaneous coronary intervention: A
Cody L Weisel1, Cornelius M Dyke2, Marilyn G Klug3
1University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58201, United States.
Insights
Elevated blood pressure variability (BPV) before percutaneous coronary intervention (PCI) is linked to worse patient outcomes, including major adverse cardiac events and death. Monitoring BPV may help identify high-risk individuals needing intervention.
Area of Science:
- Cardiology
- Clinical Research
- Medical Informatics
Background:
- Blood pressure variability (BPV) is a significant predictor of adverse cardiac events in cardiovascular disease patients.
- The impact of pre-operative BPV on outcomes following percutaneous coronary intervention (PCI) remains largely uncharacterized.
Purpose of the Study:
- To examine the association between pre-procedural blood pressure variability and clinical outcomes in patients undergoing PCI.
- To determine if BPV is an independent risk factor for adverse events post-PCI.
Main Methods:
- A cohort of 647 patients undergoing PCI in 2017 was analyzed, with 471 included based on sufficient pre-procedural blood pressure measurements (3-60 months prior).
- Systolic and diastolic BPV were quantified using standard deviation and largest change.
- Adverse outcomes, including major adverse cardiac events (MACE), myocardial infarction, stroke, death, and hospitalization, were tracked for one year post-PCI.
Main Results:
- Higher visit-to-visit systolic BPV (both standard deviation and largest change) correlated with increased rates of myocardial infarction, readmission, and death within one year.
- Elevated systolic BPV was associated with higher incidence of MACE and readmissions (P < 0.05).
- Increased diastolic BPV (largest change) was significantly linked to MACE and readmissions (P < 0.05).
Conclusions:
- Pre-procedural blood pressure variability is a novel, measurable predictor of adverse outcomes after PCI.
- Easily obtainable BPV data from electronic medical records can identify high-risk patients.
- Patients with elevated BPV undergoing PCI may benefit from aggressive risk factor modification.
Background:
For patients with cardiovascular disease, blood pressure variability (BPV), distinct from hypertension, is an important determinant of adverse cardiac events. Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention (PCI) is to this point unclear.
Aim:
To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.
Methods:
Patients undergoing PCI in a single state in 2017 were studied (n = 647). Systolic and diastolic BPV, defined as both the largest change and standard deviation for the 3-60 mo prior to PCI was calculated and patients with more than ten blood pressure measurements in that time were included for analysis (n = 471). Adverse outcomes were identified up to a year following the procedure, including major adverse cardiac events (MACE), myocardial infarction, cerebrovascular accident, death, and all-cause hospitalization.
Results:
Visit-to-visit systolic BPV, as measured by both standard deviation and largest change, was higher in patients who had myocardial infarction, were readmitted, or died within one year following PCI. Systolic BPV, as measured by largest change or standard deviation, was higher in patients who had MACE, or readmissions (P < 0.05). Diastolic BPV, as measured by largest change, was higher in patients with MACE and readmissions (P < 0.05).
Conclusion:
As BPV is easily measured and captured in the electronic medical record, these findings describe a novel method of identifying at-risk patients who undergo PCI. Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.
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