Published online May 26, 2022. doi: 10.4330/wjc.v14.i5.307
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
Processing time: 189 Days and 11.5 Hours
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.
To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.
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.
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).
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.