Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study

doi:10.1097/JS9.0000000000000928

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	Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study
	Wang, Juan 1; Lin, Fa 2; Zeng, Min 1; Liu, Minying 1; Zheng, Maoyao 1; Ren, Yue 1; Li, Shu 1; Yang, Xiaodong 3; Chen, Yiqiang 3; Chen, Xiaolin 2,6; Sessler, Daniel I.4; Peng, Yuming 1,5,6
	2024-02-01
发表期刊	INTERNATIONAL JOURNAL OF SURGERY
ISSN	1743-9191
卷号	110 期号:2 页码:965-973
摘要	Background: Previous studies report that intraoperative hypotension worsens outcomes after aneurysmal subarachnoid hemorrhage (aSAH). However, the hypotensive harm threshold for major adverse cardiovascular events (MACE) remains unclear. Methods: The authors included aSAH patients who had general anesthesia for aneurysmal clipping/coiling. MACE were defined by a composite of acute myocardial injury, acute myocardial infarction, and other cardiovascular complications identified by electrocardiogram and echocardiography. The authors initially used logistic regression and change-point analysis based on the second derivative to identify mean arterial pressure (MAP) of 75 mmHg as the harm threshold. Thereafter, our major exposure was MAP below 75 mmHg characterized by area, duration, and time-weighted average. The area below 75 mmHg represents the severity and duration of exposure and was defined as the sum of all areas below a specified threshold using the trapezoid rule. Time-weighted average MAP was derived by dividing area below the threshold by the duration of anesthesia. All analyses were adjusted for baseline risk factors including age greater than 70 years, female sex, severity of intracerebral hemorrhage, history of cardiovascular disease, and preoperative elevated myocardial enzymes. Results: Among 1029 patients enrolled, 254 (25%) developed postoperative MACE. Patients who experienced MACE were slightly older (59 +/- 11 vs. 54 +/- 11 years), were slightly more often women (69 vs. 58%), and had a higher prevalence of cardiovascular history (65 vs. 47%). Adjusted cardiovascular risk increased nearly linearly over the entire range of observed MAP. However, there was a slight inflexion at MAP of 75 mmHg. MACE was significantly associated with area [adjusted odds ratios (aOR) 1.004 per 10 mmHg.min, 95% CI: 1.001-1.007, P =0.002), duration (aOR 1.031 per 10 min, 95% CI: 1.009-1.054, P =0.006), and time-weighted average (aOR 3.516 per 10 mmHg, 95% CI: 1.818-6.801, P <0.001) of MAP less than 75 mmHg. Conclusions: Lower blood pressures were associated with cardiovascular complications over the entire observed range, but worsened when MAP was less than 75 mmHg. Pending trial data to establish causality, it may be prudent to keep MAP above 75 mmHg in patients having surgical aSAH repairs to reduce the risk of MACE.
关键词	anesthesia aneurysmal subarachnoid hemorrhage cardiac complications hypotension
DOI	10.1097/JS9.0000000000000928
收录类别	SCI
语种	英语
资助项目	Beijing Municipal Science & Technology Commission[Z191100006619068]
WOS研究方向	Surgery
WOS类目	Surgery
WOS记录号	WOS:001164676800038
出版者	LIPPINCOTT WILLIAMS & WILKINS
引用统计
文献类型	期刊论文
条目标识符	http://119.78.100.204/handle/2XEOYT63/38841
专题	中国科学院计算技术研究所
通讯作者	Chen, Xiaolin; Peng, Yuming
作者单位	1.Capital Med Univ, Beijing Tiantan Hosp, Dept Anesthesiol, Beijing, Peoples R China 2.Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China 3.Chinese Acad Sci, Inst Comp Technol, Beijing, Peoples R China 4.Cleveland Clin, Dept Outcome Res, Cleveland, OH USA 5.Outcome Res Consortium, Cleveland, OH USA 6.Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, 119 Nansihuan Xilu, Beijing 100160, Peoples R China
推荐引用方式 GB/T 7714	Wang, Juan,Lin, Fa,Zeng, Min,et al. Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study[J]. INTERNATIONAL JOURNAL OF SURGERY,2024,110(2):965-973.
APA	Wang, Juan.,Lin, Fa.,Zeng, Min.,Liu, Minying.,Zheng, Maoyao.,...&Peng, Yuming.(2024).Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study.INTERNATIONAL JOURNAL OF SURGERY,110(2),965-973.
MLA	Wang, Juan,et al."Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study".INTERNATIONAL JOURNAL OF SURGERY 110.2(2024):965-973.