Visit‐to‐Visit Systolic Blood Pressure Variability Predicts Long‐Term Cardiovascular Events After Coronary Artery Bypass Grafting

Figures

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  FIGURE 1. Study flowchart of patient selection and follow‐up. Diagram illustrating the recruitment process of the study cohort. Of the 158 consecutive patients screened between January 2020 and January 2024, 120 met the inclusion criteria and were enrolled in the transitional care service system. Common reasons for exclusion were concomitant surgery (n = 8), insufficient BP measurements (n = 22), and emergency status (n = 5). The final cohort was stratified into Low Variability and High Variability groups based on the median CV of systolic BP.

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  FIGURE 2. Kaplan–Meier estimates of event‐free survival. Kaplan–Meier survival curves for the primary composite endpoint (MACCE: major adverse cardiac and cerebrovascular events) over the 48‐month follow‐up period post‐landmark. The analysis strictly includes the 116 patients who survived event‐free to the 12‐month landmark. The blue solid line represents the Low systolic blood pressure variability (low SBPV) group, and the red dashed line represents the high systolic blood pressure variability (high SBPV) group. The high SBPV group demonstrated a significantly lower probability of event‐free survival compared to the Low SBPV group (log‐rank test p = 0.005).

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  FIGURE 3. Forest plot of multivariable cox proportional hazards model. Forest plot illustrating the hazard ratios (HR) and 95% confidence intervals (CI) for predictors of MACCE in the landmark cohort (n = 116). The model was adjusted for age, diabetes mellitus, mean systolic BP, and number of BP measurements. The vertical dashed line indicates an HR of 1.0 (no effect). High SBP variability (red square) is the only statistically significant predictor, with the CI not crossing the reference line (HR 2.85, 95% CI 1.12–7.24, p = 0.028). Other variables including diabetes, mean SBP, and number of BP measurements were not statistically significant in this cohort.

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  FIGURE 4. Comparative forest plot of sensitivity analyses. This forest plot summarizes the adjusted hazard ratios (HR) for the primary endpoint (MACCE) according to three different metrics of SBPV: CV, SD, and VIM. The central marker represents the point estimate of the HR, and the error bars represent the 95% confidence intervals. All three metrics show a consistent, statistically significant association with adverse outcomes, confirming that the prognostic value of BP variability is robust and independent of the calculation method.