Document Detail

Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery.
MedLine Citation:
PMID:  18396057     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: There is substantial evidence to consider both heart rate (HR) at rest and pulse pressure (PP) as significant markers of cardiovascular prognosis in the general population. Despite this, neither of these two parameters has been taken into consideration in the design of modern coronary artery bypass risk prediction scores, and little data on their early postoperative prognostic value are currently available. We aimed to assess the predictive value of preoperative HR and PP in the 30-day postoperative period. METHODS: We prospectively enrolled all patients referred to our institution for non-urgent coronary artery bypass grafting. We measured HR on ECG at admittance. Preoperative pulse pressure was obtained by the difference of the mean of three consecutive systolic and diastolic blood pressures. The primary outcome combined the 30-day postoperative mortality, myocardial infarction (new Q-waves on ECG or Troponin-I >20 microg/l) and stroke or transient ischemic attack. The secondary outcome corresponded to clinical events only (stroke or death). Statistical analysis was performed by usual methods. RESULTS: We enrolled 1022 patients (age 66.9+/-9.2 years). Those meeting the primary outcome (n=146) had a significantly higher HR (69.9+/-14.3 bpm vs 64.9+/-13.2 bpm, p<0.0001) and a higher proportion presented a PP >70 mmHg (17.1% vs 10.2%, p<0.03). After adjustments for age, gender, systolic blood pressure, preoperative beta-blocker therapy, left ventricular ejection fraction <0.40, unstable cardiac status, redo surgery, peripheral arterial disease, renal failure, and combined vascular surgery, both HR (OR=1.17 per 10 bpm, p<0.03) and PP >70 mmHg (OR=1.99, p=0.03) remained significant risk predictors. Similar results were found when considering only clinical events. CONCLUSION: This prospective study highlights the usefulness of HR and PP as preoperative risk markers in CABG candidates.
Victor Aboyans; Michael Frank; Karine Nubret; Philippe Lacroix; Marc Laskar
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Publication Detail:
Type:  Journal Article     Date:  2008-04-08
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  33     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-16     Completed Date:  2008-08-21     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  971-6     Citation Subset:  IM    
Department of Thoracic & Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France.
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MeSH Terms
Blood Pressure*
Cohort Studies
Coronary Artery Bypass* / mortality
France / epidemiology
Heart Rate*
Middle Aged
Myocardial Infarction / etiology
Postoperative Complications*
Rest / physiology
Risk Factors
Stroke / etiology
Treatment Outcome
Comment In:
Eur J Cardiothorac Surg. 2009 Apr;35(4):746; author reply 746-7   [PMID:  19208483 ]

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