Association of Post-operative Systolic Blood Pressure Variability With Mortality After Coronary Artery Bypass Grafting
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Key result
In patients undergoing coronary artery bypass grafting, the highest quartile of post-operative systolic blood pressure variability was associated with a significantly higher risk of 30-day mortality (OR 1.92) compared to the lower three quartiles.
Why the study?
Blood pressure variability is a known cardiovascular risk factor, but its association with early and late all-cause mortality after CABG required investigation.
Does higher post-operative systolic blood pressure variability increase mortality in patients undergoing coronary artery bypass grafting?
Population
4,509 patients undergoing CABG between 2001 and 2012 from the MIMIC-III database
Comparison
Highest quartile of systolic BPV vs the other three quartiles
Design
Retrospective database cohort study
Follow-up
Up to 4 years
Authors
Discussion
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Implication
Postoperative BPV may signal higher CABG mortality risk; leaves open whether it is modifiable or warrants intervention.
Study Design
Type
Cohort (n=4,509)
Multicenter
No
Structured PICO
Does higher post-operative systolic blood pressure variability increase mortality in patients undergoing coronary artery bypass grafting?
P
Population
4,509 patients (mean age 68 years, 26% female) undergoing coronary artery bypass grafting, followed for at least 90 days to assess the impact of post-operative blood pressure variability.
E
Exposure
Highest quartile (Q4) of post-operative systolic blood pressure variability (BPV) within the first 24 hours in the intensive care unit.
C
Comparator
The other three quartiles (Q1-3) of post-operative systolic blood pressure variability (BPV) within the first 24 hours in the intensive care unit.
O
Outcome
All-cause mortality occurring within 30 days after the CABG operation.hard clinical
Main Result
Odds Ratio: 1.92 (95% CI 1.22–3.02)
Absolute Event Rate: 3.46% vs 1.45%
Limitations
- Most included patients received medications that limit the natural variation of blood pressure, potentially biasing results toward statistical insignificance.
- Definition of comorbidities based on ICD-9-CM codes might not be specific enough.
- Important information including preoperative risk scores, urgent or emergent surgery, intraoperative details, and cardiovascular events were not available in the database.
- The single-center-based cohort limits the generalizability of the conclusions.
- Medications limit the natural variation of BP, which would be expected to bias results toward statistical insignificance.
- Definition of comorbidities based on ICD-9-CM codes potentially not specific enough.
- Single-center-based cohort limits the generalizability of the conclusions.
Cite This Study
Zhou et al. (2021) conducted a cohort in Coronary artery disease requiring coronary artery bypass grafting (CABG) (n=4,509). Highest quartile of post-operative systolic blood pressure variability vs. Lower three quartiles of systolic blood pressure variability was evaluated on All-cause mortality occurring within 30 days after the CABG operation (OR 1.92, 95% CI 1.22-3.02). In patients undergoing coronary artery bypass grafting, the highest quartile of post-operative systolic blood pressure variability was associated with a significantly higher risk of 30-day mortality (OR 1.92) compared to the lower three quartiles.
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