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Postoperative Dipping Patterns of Mean Arterial Pressure and Mortality After Coronary Artery Bypass Grafting

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Abstract

Blood pressure dipping patterns have long been considered to be associated with adverse events. We aimed to investigate whether dipping patterns of postoperative MAP were related to 90-day and hospital mortality in patients undergoing CABG. Four thousand three hundred ninety-one patients were classified into extreme dippers (night-to-day ratio of MAP ≤ 0.8), dippers (0.8 < night-to-day ratio of MAP ≤ 0.9), non-dippers (0.9 < night-to-day ratio of MAP ≤ 1), and reverse dippers (> 1). Compared with non-dippers, reverse dippers were at a higher risk of 90-day mortality (aHR = 1.58; 95% CI, 1.10–2.27) and hospital mortality (aOR = 1.97; 95% CI, 1.12–3.47). A significant interaction was observed between hypertension and dipping patterns (P for interaction = 0.02), with a significant increased risk of 90-day mortality in non-hypertensive reverse dippers (aHR = 1.90; 95% CI, 1.17–3.07) but not in hypertensive reverse dippers (aHR = 1.26; 95% CI, 0.73–2.19).

Graphical Abstract

Patients with the reverse dipping pattern have a higher risk of 90-day mortality after receiving CABG, while the association between dipping patterns and mortality was moderated by hypertension.

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Data Availability

The data underlying this article are available in the Medical Information Mart for Intensive Care III (MIMIC-III) database, at https://mimic.mit.edu. Our right to access the database and acquire the data was approved by the institutional review board of the Massachusetts Institute of Technology (Cambridge, MA, USA) after one of our authors (ZZ) finished the online training for the Collaborative Institutional Training Initiative program of the National Institutes of Health (Record ID 35971811).

Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

MAP:

Mean arterial pressure

ICU:

Intensive care unit

BP:

Blood pressure

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

ACEIs:

Angiotensin-converting enzyme inhibitors

ARBs:

Angiotensin receptor blockers

CCBs:

Calcium channel blocker

HR:

Hazard ratio

OR:

Odds ratio

CI:

Confidence interval

MIMIC-III:

The Medical Information Mart for Intensive Care III database

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Acknowledgements

We thank the investigators of the Beth Israel Deaconess Medical Center for sharing the MIMIC-III database. The Graphical Abstract was created with materials from Biorender.com.

Funding

This work was funded by the National Key Research and Development Program of Guangzhou (Grant number 202103000014 to Zhongkai Wu), the Natural Science Funds of Guangdong Province (grant numbers 2019A1515010218 to Mengya Liang), and the National Natural Science Foundation of China (grant numbers 82070297 and 82370271 to Zhongkai Wu).

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Author notes

  1. Bohao Jian, Haoliang Liu, and Yi Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Bohao Jian, Haoliang Liu, Yi Zhang, Gang Li, Guangguo Fu, Suiqing Huang, Yang Huang, Zhuoming Zhou, Zhongkai Wu & Mengya Liang

  2. Department of Cardiothoracic Surgical ICU, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Song Yang

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Contributions

All co-authors have made a substantial and intellectual contribution to the work and approved the submitted article. B.J., Z.Z., and M.L., conceived and designed the research. B.J., H.L., and Z.Z. preformed data collection, statistical analysis, and visualization. The manuscript was written by Z.Z. and B.J. and revised by all co-authors.

Corresponding authors

Correspondence to Zhuoming Zhou, Zhongkai Wu or Mengya Liang.

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Given the nature of our study, the institutional review board of the First Affiliated Hospital of Sun Yat-sen University waived the need for ethic approval for this study.

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Jian, B., Liu, H., Zhang, Y. et al. Postoperative Dipping Patterns of Mean Arterial Pressure and Mortality After Coronary Artery Bypass Grafting. J. of Cardiovasc. Trans. Res. 17, 287–297 (2024). https://doi.org/10.1007/s12265-023-10475-6

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