Key result
An average mean arterial pressure of 80-90 mmHg during the first 24 hours of admission significantly reduced in-hospital mortality (OR 0.003) compared to <70 mmHg in intermediate/high-risk PE.
Why the study?
While systolic and diastolic blood pressure relate to mortality in pulmonary embolism, the utility of average mean arterial pressure within the first 24 hours of admission for predicting short-term outcomes in intermediate-risk and high-risk PE remained unclear.
Does average mean arterial pressure (aMAP) in the first 24 hours of admission predict in-hospital mortality in patients with intermediate-risk and high-risk pulmonary embolism?
Cohort (n=122)
No
Does average mean arterial pressure (aMAP) in the first 24 hours of admission predict in-hospital mortality in patients with intermediate-risk and high-risk pulmonary embolism?
An average mean arterial pressure of 80-90 mmHg during the first 24 hours of admission is associated with the lowest risk of in-hospital mortality and adverse events in patients with intermediate- and high-risk pulmonary embolism.
Supports targeting aMAP 80-90 mmHg in intermediate/high-risk PE; hypothesis-generating and requires prospective validation.
Objective: Pulmonary embolism is a terrible cardiovascular condition with considerable morbidity and mortality. Previous studies have investigated systolic blood pressure (systolic BP) and diastolic blood pressure (diastolic BP) as being related to 30-day and in-hospital mortality. We aimed to determine whether the average mean arterial pressure (aMAP) in the first 24 hours of hospital admission is useful in predicting short-term outcomes of intermediate-risk and high-risk PE patients. Method: We conducted a single-center retrospective study. From May 2012 to April 2019, 122 intermediate-risk and high-risk PE patients were included. The primary outcome was in-hospital mortality. The secondary outcome was adverse events. ROC curves and cut-off values for aMAP predicting in-hospital death were computed. According to cut-off values, we categorized five groups defined as follows: group 1: aMAP<70 mmHg; group 2: 70 mmHg≤aMAP<80 mmHg; group 3: 80 mmHg≤aMAP<90 mmHg; group 4: 90 mmHg≤aMAP<100 mmHg; and group 5: aMAP≥100 mmHg. Cox regression models were calculated to investigate associations between aMAP and in-hospital death. Results: In the study group of 122 patients, 15 patients (12.30%) died in the hospital due to PE. ROC analysis for MAP predicting in-hospital death revealed an AUC of 0.729 with a cut-off value of 79.4 mmHg. Cox regression models showed a significant association between in-hospital death and aMAP group 1 (ref), aMAP group 2 (OR 1.680, 95% CI 0.020-140.335), aMAP group 3 (OR 0.003, 95% CI 0.0001-0.343), aMAP group 4 (OR 0.006, 95% CI 0.0001-1.671), and aMAP group 5 (OR 0.003, 95% CI 0.0001-9.744). In particular, those with an aMAP of 80-90 mmHg suffer from minimum adverse events. Conclusion: The prognostic role of MAP during the first 24 hours of hospital admission should be emphasized in patients with PE. The optimal range of MAP for intermediate-risk and high-risk PE patients may be 80 to 90 mmHg.
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Chen et al. (2020) conducted a cohort in Intermediate-risk and high-risk pulmonary embolism (n=122). Average mean arterial pressure (aMAP) 80-90 mmHg vs. aMAP <70 mmHg was evaluated on In-hospital mortality (OR 0.003, 95% CI 0.0001-0.343, p=<0.05). An average mean arterial pressure of 80-90 mmHg during the first 24 hours of admission significantly reduced in-hospital mortality (OR 0.003) compared to <70 mmHg in intermediate/high-risk PE.
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