Key result
High preoperative ambulatory BP linked to ~5-fold greater 30-day adverse event risk after CABG.
Why the study?
It was unknown whether unwitnessed BP measurement or ambulatory BP monitoring improves the prediction of adverse events estimated by risk scores in patients undergoing cardiac surgery.
Does high preoperative blood pressure measured by ABP monitoring predict adverse outcomes in patients undergoing cardiac surgery?
Cohort (n=167)
Does high preoperative blood pressure measured by ABP monitoring predict adverse outcomes in patients undergoing cardiac surgery?
Absolute Event Rate: 53% vs 10%
p-value: p=<0.01
High preoperative blood pressure measured by 24-hour ambulatory monitoring is a significant risk factor for 30-day postoperative complications in patients undergoing CABG.
May warrant preoperative ABP risk stratification in CABG; leaves open whether optimization reduces complications.
BACKGROUND: It is unknown whether unwitnessed BP (UBP) measurement or ambulatory BP (ABP) monitoring improves the prediction of adverse events estimated by risk scores. We intended to study associations between preoperative BP measured through these two methods and the incidence of adverse outcomes in patients undergoing cardiac surgery. METHODS: We included a cohort of 167 patients undergoing elective or urgent cardiac surgeries. Preoperative BP was measured by UBP and 24-hour ABP. Primary outcome was the combination of mortality from any cause, nonfatal myocardial infarction, nonfatal stroke, new hospital admission, and dialysis occurring within 30 days after surgery. The associations between preoperative BP and surgical outcomes were tested using the Chi-square test and Analysis of Variance. A generalized linear model with a logistic link function and a robust estimator was used to adjust for the EuroScore-II risk estimation. RESULTS: The incidence of the primary outcome increased in parallel with the quartiles of the 24-hour ABP in participants submitted to CABG: 10% in the first quartile, 13% in the second, 37% in the third, and 53% in the fourth quartile (P for trend<0.01). Quartiles of overnight ABP were also significantly associated with postoperative complications in patients undergoing CABG (P=0.04). The risks in CABG patients were independent of the EuroScore-II. There was no association between BP and outcomes in patients submitted to other surgeries. CONCLUSIONS: High preoperative BP measured by ABP monitoring is a risk factor for postoperative complications in patients submitted to CABG.
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Silveira et al. (2023) conducted a cohort in Patients undergoing elective or urgent cardiac surgeries (n=167). 24-hour ambulatory blood pressure (ABP) monitoring vs. Lower quartiles of 24-hour ABP was evaluated on Combination of mortality from any cause, nonfatal myocardial infarction, nonfatal stroke, new hospital admission, and dialysis occurring within 30 days after surgery (p=<0.01). High preoperative blood pressure measured by 24-hour ambulatory BP monitoring was associated with increased 30-day adverse outcomes in CABG patients (53% in 4th quartile vs 10% in 1st; P<0.01).
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