Pulse pressure and risk of adverse outcome in coronary bypass surgery.
Publication/Presentation Date
10-1-2008
Abstract
BACKGROUND: Among ambulatory patients, an increase in pulse pressure (PP) is a well-established determinant of vascular risk. The relationship of PP and acute perioperative vascular outcome among patients having coronary artery bypass graft (CABG) surgery is less well known.
METHODS: We conducted a prospective observational study involving 5436 patients having elective CABG surgery requiring cardiopulmonary bypass. Of these, 4801 met final inclusion criteria. Comprehensive data were captured for medical history, intraoperative and postoperative physiologic and laboratory measures, diagnostic testing, and clinical events. The relationship between preoperative hypertension (systolic, diastolic, PP) and ischemic cardiac and cerebral outcomes and death was assessed using multivariable logistic regression; P
RESULTS: Nine hundred and seventeen patients (19.1%) had fatal and nonfatal vascular complications, including 146 patients (3.0%) with cerebral and 715 patients (14.9%) with cardiac events. In-hospital mortality occurred in 147 patients (3.1%). Among all blood pressure variables measured preoperatively, PP was most strongly associated with an increased risk of postoperative complications. PP increments of 10 mm Hg (above a threshold of 40 mm Hg) were associated with an increased risk of cerebral events (adjusted odds ratio: 1.12; 95% CI [1.002-1.28]; P=0.026). The incidence of a cerebral event and/or death from neurologic complications nearly doubled for patients with PP>80 mm Hg versus
CONCLUSION: An increase in PP was independently and significantly associated with greater fatal and nonfatal adverse cerebral and cardiac outcomes in patients having CABG surgery. These findings highlight the associated risks of preoperative PP on acute postoperative vascular outcomes.
Volume
107
Issue
4
First Page
1122
Last Page
1129
ISSN
1526-7598
Published In/Presented At
Fontes, M. L., Aronson, S., Mathew, J. P., Miao, Y., Drenger, B., Barash, P. G., Mangano, D. T., Multicenter Study of Perioperative Ischemia (McSPI) Research Group, & Ischemia Research and Education Foundation (IREF) Investigators (2008). Pulse pressure and risk of adverse outcome in coronary bypass surgery. Anesthesia and analgesia, 107(4), 1122–1129. https://doi.org/10.1213/ane.0b013e31816ba404
Disciplines
Anesthesiology | Medicine and Health Sciences
PubMedID
18806013
Department(s)
Department of Anesthesiology
Document Type
Article