Prognostic Implications of Orthostatic Hypotension in Elective Coronary Artery Bypass Grafting

BACKGROUND Orthostatic hypotension (OH), defined as a sustained drop in systolic or diastolic blood pressure upon standing, is known to negatively affect survival in the general population. However, its impact on outcomes in patients with advanced coronary artery disease remains unclear. The aim of this study was to assess the prevalence and prognostic value of OH in patients undergoing isolated coronary artery bypass grafting (CABG). MATERIAL AND METHODS This prospective observational study enrolled 392 patients (74.7% male, median age 66 [61-74] years) scheduled for elective CABG between 2013 and 2016. Structured clinical interviews and orthostatic tests (OT) were performed preoperatively. OH was diagnosed using standard criteria. Survival status was obtained from the Polish Ministry of Digitization on August 31, 2024. Cox regression and logistic regression were used to identify predictors of long-term mortality. RESULTS The median follow-up was 9.7 (9.0-10.5) years. OH was diagnosed in 80 patients (20.4%). During follow-up, 148 patients (37.8%) died. OH-positive patients had higher baseline systolic and diastolic blood pressure (P 0.001), but did not differ significantly from OH-negative patients in other clinical variables. Independent predictors of mortality included advanced age, male sex, heart failure, and renal failure. OH was not associated with long-term mortality (odds ratio: 0.694; 95% CI: 0.386-1.246; P=0.22). CONCLUSIONS Orthostatic hypotension is present in approximately 20% of patients undergoing elective CABG. A positive orthostatic test prior to surgery does not independently affect long-term survival in this population.