Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Day-to-day blood pressure variability predicts poor outcomes following percutaneous coronary intervention: A retrospective study
Cody L Weisel, Cornelius M Dyke, Marilyn G Klug, Thomas A Haldis, Marc D Basson
Cody L Weisel, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58201, United States
Cornelius M Dyke, Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58201, United States
Cornelius M Dyke, Department of Surgery, Sanford Medical Center, Fargo, ND 58104, United States
Marilyn G Klug, Population Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58201, United States
Thomas A Haldis, Department of Cardiology, Sanford Medical Center, Fargo, ND 58104, United States
Marc D Basson, Department of Surgery, Pathology and Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
Author contributions: Weisel CL, Dyke CM, Haldis TA, and Basson MD designed the research study; Weisel CL, Dyke CM, Klug MG, Haldis TA, and Basson MD performed the research study; Klug MG contributed new analytic tools; Weisel CL, Klug MG, and Basson MD analyzed the data; Weisel CL, Dyke CM, Klug MG, Haldis TA, and Basson MD wrote the manuscript; and All authors have read and approved the final manuscript.
Institutional review board statement: The institutional review board determined, on 2/28/2018, that the proposed activity is not human research.
Informed consent statement: There are no informed consent documents because this was a retrospective study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Marc D Basson, MD, PhD, Professor, Department of Surgery, Pathology and Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd Stop 9307, Grand Forks, ND 58202, United States. marc.basson@und.edu
Received: November 9, 2021
Peer-review started: November 9, 2021
First decision: February 8, 2022
Revised: March 10, 2022
Accepted: April 15, 2022
Article in press: April 15, 2022
Published online: May 26, 2022
BACKGROUND
For patients with cardiovascular disease, blood pressure variability (BPV), distinct from hypertension, is an important determinant of adverse cardiac events. Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention (PCI) is to this point unclear.
AIM
To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.
METHODS
Patients undergoing PCI in a single state in 2017 were studied (n = 647). Systolic and diastolic BPV, defined as both the largest change and standard deviation for the 3-60 mo prior to PCI was calculated and patients with more than ten blood pressure measurements in that time were included for analysis (n = 471). Adverse outcomes were identified up to a year following the procedure, including major adverse cardiac events (MACE), myocardial infarction, cerebrovascular accident, death, and all-cause hospitalization.
RESULTS
Visit-to-visit systolic BPV, as measured by both standard deviation and largest change, was higher in patients who had myocardial infarction, were readmitted, or died within one year following PCI. Systolic BPV, as measured by largest change or standard deviation, was higher in patients who had MACE, or readmissions (P < 0.05). Diastolic BPV, as measured by largest change, was higher in patients with MACE and readmissions (P < 0.05).
CONCLUSION
As BPV is easily measured and captured in the electronic medical record, these findings describe a novel method of identifying at-risk patients who undergo PCI. Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.
Core Tip: Pre-procedural visit-to-visit blood pressure variability, as measured by either standard deviation or largest change between two consecutive visits, is higher in patients who are readmitted, have complications, or die after percutaneous coronary intervention. Aggressive risk modification is indicated for patients with elevated blood pressure variability and known coronary artery disease.
