Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock

Burstein, Barry; Tabi, Meir; Barsness, Gregory W.; Bell, Malcolm R.; Kashani, Kianoush; Jentzer, Jacob C.

doi:10.1186/s13054-020-03217-6

Cited by 47 publications

(46 citation statements)

References 20 publications

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“…In a Swedish prospective cohort study, Fedorowski et al (27) found that the postural changes in MAP were associated with the incidence of the first hospitalization due to newonset HF in 32,669 individuals over a follow-up of 24 years. Moreover, lower MAP was linked to increased all-cause mortality among 123 consecutive patients hospitalized for acute HF (18) and among 1,002 patients with cardiogenic shock (17). Our study reports the association of MAP variability with HF and death in a large cohort from the ARIC study.…”

Section: Discussionmentioning

confidence: 66%

“…The clinical prognostic power of MAP in predicting the risk for CVD was reported to be even superior to that of SBP and DBP (16). Moreover, several studies showed that MAP was associated with a hospital or long-term mortality in patients with cardiogenic shock or heart failure (HF) (17,18). Therefore, to provide evidence on BP variability assessed by MAP, our study was to evaluate the association of long-term visit-to-visit MAP variability with the risks of HF and death in community population using the Atherosclerosis Risk in Communities (ARIC) study (19).…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Liu

Chen

Zhang

et al. 2021

Front. Cardiovasc. Med.

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Background: Systolic or diastolic blood pressure (BP) variability is associated with an increased risk of cardiovascular events. We assessed whether BP variability measured by mean arterial pressure (MAP) was associated with increased risk of heart failure (HF) and death in individuals with or without hypertension.Methods: We evaluated 9,305 Atherosclerosis Risk in Communities (ARIC) study participants with or without hypertension and calculated BP variability based on MAP values from visit 1 to 4 [expressed as standard deviation (SD), average real variability (ARV), coefficient of variation (CV), and variability independent of the mean (VIM)]. Multivariate-adjusted Cox regression model and restricted cubic spline curve were used to evaluate the associations of MAP variability with all-cause mortality and HF.Results: During a median follow-up of 16.8 years, 1,511 had an HF event and 2,903 died. Individuals in the highest quartile of VIM were both associated with a 21% higher risk of all-cause mortality [hazard ratio (HR), 1.21; 95% CI, 1.09–1.35] and HF (HR, 1.21; 95% CI, 1.04–1.39) compared with the lowest quartile of VIM. Cubic spline curves reveal that the risk of deaths and HF increased with MAP variability when it reached a higher level. Results were similar in individuals with normotension (all-cause mortality: HR, 1.30; 95% CI, 1.09–1.55; HF, HR, 1.49; 95% CI, 1.12–1.98).Conclusions: In individuals with or without hypertension, greater visit-to-visit MAP variability was associated with a higher risk of all-cause mortality and HF, indicating that the BP variability assessed by MAP might be a potential risk factor for HF and death.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Liu

Chen

Zhang

et al. 2021

Front. Cardiovasc. Med.

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“…Demographics, vital signs, laboratory results, diagnoses, procedures, therapies and length of stay (LOS) were extracted from the electronic medical record (EMR) through the Multidisciplinary Epidemiology and Translational Research in Intensive Care Data Mart [ 18 , 19 ]. Admission diagnoses were defined as all International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes recorded within one day before or after CICU admission [ 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients

et al. 2021

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Purpose We sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients. Materials and methods We retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis. Results 9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5–3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6–2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6–2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1–1.6; p<0.001). Conclusion Abnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.

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“…Expert consensus has a novel CS classification categorizing patients with or at risk of CS into 5 worsening stages of CS. Hypotension necessitating vasoactive pharmacological treatment or mechanical circulatory support is often present [7,9]. However, the clinical presentation can vary significantly between patients, possibly delaying the diagnosis and treatment [7].…”

Section: W H a T ' S N E W ?mentioning

confidence: 99%

“…However, hypoperfusion is often associated with low blood pressure and blood pressure is an easily obtainable parameter that can be measured by non-physicians already prehospitally without the need for invasive catheters. Furthermore, low blood pressure has been shown to be a prognostic factor in CS, with lower blood pressure being associated with worse outcome [9]. Consequently, the Acute Cardiovascular Care Association's (ACVC) position statement for AMI-related CS has included hypotension (systolic blood pressure <90 mm Hg for >30 min or use of vasopressors to maintain pressure >90 mm Hg during systole) as one of the criteria for CS [8].…”

Section: Blood Pressurementioning

confidence: 99%

Randomized clinical trials of patients with acute myocardial infarction-related cardiogenic shock: a systematic review of used cardiogenic shock definitions and outcomes

et al. 2021

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Background: Cardiogenic shock (CS) is a critical complication to acute myocardial infarction (AMI), with short-term mortality rates exceeding 40%. However, no international consensus of a CS definition exists. This may compromise interstudy comparability. Aims:The aim of the current study was to review differences and similarities of CS enrolment criteria in AMI-related CS randomized clinical trials (RCT).Methods: From the electronic databases MEDLINE and EMBASE we identified all AMI-related CS trials.Results: A total of 19 trials comprising a total of 2674 unique patients with CS were identified. Seven trials investigated left ventricular assist devices, eight investigated medical treatments, three percutaneous coronary intervention (PCI), and one trial investigated targeted temperature management. The inclusion criteria, baseline hemodynamics, endpoints, and mortality varied markedly between trials. Hypotension was the most frequent overall inclusion criterion (17 [90%] trials), and a systolic blood pressure <90 mm Hg (and/or need of vasopressors) was the most frequently used limit. Twelve (63%) trials had signs of impaired end-organ perfusion as an inclusion criterion and 10 (53%) signs of impaired cardiovascular function most frequently low cardiac index and reduced left ventricular ejection fraction. Ten (53%) trials included patients resuscitated from a cardiac arrest, three trials excluded cardiac arrest patients whereas six trials did not state whether cardiac arrest was an exclusion criterion. Mortality ranged from 8% to 73%. Conclusions:The RCTs of AMI-related CS have marked heterogeneity in enrolment criteria and outcomes potentially hampering interstudy comparability. The overall consensus of CS enrolment criteria appears needed for future selection of patients.

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Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock

Cited by 47 publications

References 20 publications

Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients

Randomized clinical trials of patients with acute myocardial infarction-related cardiogenic shock: a systematic review of used cardiogenic shock definitions and outcomes

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