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
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.
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.
To determine whether BPV represents an independent risk factor for poor outcomes after percutaneous coronary angioplasty.
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.
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).
BPV represents an independent risk factor for poor outcomes after PCI.
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.