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
ARTICLE HIGHLIGHTS
Research background
Blood pressure variability (BPV), distinct from hypertension, is known to be a risk factor for long term complications, and has recently been shown to increase the acute risk of postoperative death, hospitalization, or other complications for patients undergoing major surgical procedures.
Research motivation
The impact of BPV on outcomes after the less invasive procedure of percutaneous coronary interventions (PCI) has not previously been explored despite the high risk nature of these patients.
Research objectives
To determine whether BPV represents an independent risk factor for poor outcomes after percutaneous coronary angioplasty.
Research methods
Six hundred and forty-seven patients undergoing PCI in a single state in 2017 were prospectively enrolled in a patient registry which was then retrospectively analyzed. Systolic and diastolic BPV were calculated as both the largest consecutive change between blood pressure measurements and the standard deviation of all blood pressure measurements for the 30-60 mo prior to PCI, considering only the 471 patients with more than ten blood pressure measurements for analysis. Other variables including demographics, prior diagnoses and medication use were retrieved. Procedural indications were categorized as staged PCI, non-STEMI, or other. Adverse outcomes were identified for up to a year following the procedure, including MACE, myocardial infarction, cerebrovascular accident, death, and all-cause hospitalization.
Research results
Even after taking into account other patient characteristics, visit-to-visit systolic BPV, as measured by both standard deviation and largest change, was higher in patients who had myocardial infarctions, were readmitted, or died within one year following PCI. Systolic BPV was higher in patients who had major adverse cardiac events (MACE), or readmissions (P < 0.05). Diastolic BPV, as measured by largest change, was higher in patients with MACE and readmissions (P < 0.05).
Research conclusions
BPV represents an independent risk factor for poor outcomes after PCI.
Research perspectives
BPV is easily measured and captured from the electronic medical record. Cardiologists performing PCI should consider high BPV in choosing among procedural outcomes or observation, and should follow patients with high BPV more closely after PCI. Patients with high BPV should be counseled about this risk factor in the informed consent process and should be counseled to work more aggressively to reduce other more modifiable risk factors after PCI in the face of their BPV.
