Association of Post-operative Systolic Blood Pressure Variability With Mortality After Coronary Artery Bypass Grafting

Abstract

Background: Blood pressure variability (BPV) has long been considered a risk factor for cardiovascular events. We aimed to investigate whether post-operative systolic BPV was associated with early and late all-cause mortality in patients undergoing coronary artery bypass grafting (CABG).Methods: Clinical variables and blood pressure records within the first 24 h in the post-operative intensive care unit stay from 4,509 patients operated on between 2001 and 2012 were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. BPV was measured as the coefficient of the variability of systolic blood pressure, and we compared patients in the highest quartile with patients in the other three quartiles.Results: After full adjustment, patients in the highest quartile of BPV were at a higher risk of intensive care unit mortality (OR = 2.02, 95% CI: 1.11–3.69), 30-day mortality (OR = 1.92, 95% CI: 1.22–3.02), and 90-day mortality (HR = 1.64, 95% CI: 1.19–2.27). For 2,892 patients with a 4-year follow-up, the association between a higher post-operative BPV and the risk of 4-year mortality was not significant (HR = 1.17, 95% CI: 0.96–1.42). The results were supported by the comparison of survival curves and remained generally consistent in the subgroup analyses and sensitivity analyses.Conclusions: Our findings demonstrated that in patients undergoing CABG, a higher post-operative BPV was associated with a higher risk of early mortality while the association was not significant for late mortality. Post-operative BPV can support doctors in identifying patients with potential hemodynamic instability and making timely clinical decisions.

Effects of Concurrent Aerobic Plus Resistance Training on Blood Pressure Variability and Blood Pressure Values in Patients with Hypertension and Coronary Artery Disease: Gender-Related Differences

“…To our knowledge, this is the first study showing a positive impact of an exercise training modality on short-term BPV in women. This result appears to have potential implications in the clinical practice: an elevated BPV has been associated with an increased risk of cardiovascular events in patients with already diagnosed CAD [ 23 , 24 ]. Regarding diastolic short-term BPV, its prognostic role has also been underlined recently: in a study involving more than 9000 subjects with hypertension, diastolic short-term BPV was directly and independently related to cardiovascular mortality across all ages [ 25 ].…”

Machine learning‐based prediction of 1‐year mortality in hypertensive patients undergoing coronary revascularization surgery

“…7 Moreover, increased postoperative complications, early mortality, and 2-year mortality have been reported, compared to nonhypertensive patients. 7,8 This was reported to be an up to 40% increase in perioperative morbidity in hypertensive patients undergoing CABG. 9 Besides traditional risk scores, machine learning (ML)developed models are getting attention for outcome prediction after cardiac surgeries.…”

“…Hypertensive patients tend to have different risk factor patterns from other CABG patients 7 . Moreover, increased postoperative complications, early mortality, and 2‐year mortality have been reported, compared to nonhypertensive patients 7,8 . This was reported to be an up to 40% increase in perioperative morbidity in hypertensive patients undergoing CABG 9 …”