title: Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery.
abstract: Evidence that intraoperative hemodynamic abnormalities influence outcome is limited. The purpose of this study was to determine whether intraoperative hemodynamic abnormalities were associated with mortality, stroke, or perioperative myocardial infarction (PMI) in a large cohort of patients undergoing coronary artery bypass grafting. Risk factors and outcomes were queried from a state-mandated cardiac surgery reporting system at two hospitals in New York, NY. Intraoperative hemodynamic abnormalities were derived from computerized anesthesia records by assessing the duration of exposure to moderate or severe extremes of hemodynamic variables. Multivariate logistic regression identified independent predictors of perioperative mortality, stroke, and PMI. Among 2149 patients, there were 50 mortalities, 51 strokes, and 85 PMIs. In the precardiopulmonary bypass (pre-CPB) period, pulmonary hypertension was a predictor of mortality (odds ratio [OR] 2.1, P = 0.029), and bradycardia and tachycardia were predictors of PMI (OR 2.9, P = 0.007 and OR 2.0, P = 0.028, respectively). During CPB, hypotension was a predictor of mortality (OR 1.3, P = 0.025). Post-CPB, tachycardia was a predictor of mortality (OR 3.1, P = 0.001), diastolic arterial hypertension was a predictor of stroke (OR 5.4, P = 0.012), and pulmonary hypertension was a predictor of PMI (OR 7.0, P < 0.001). Increased pulmonary arterial diastolic pressure post-CPB was a predictor of mortality (OR 1.2, P = 0.004), stroke (OR 3.9, P = 0.002), and PMI (OR 2.2, P = 0.001). Rapid intraoperative variations in blood pressure and heart rate were not independent predictors of these outcomes. These findings demonstrate the prognostic significance of intraoperative hemodynamic abnormalities, including data from pulmonary artery catheterization, to adverse postoperative outcomes. It is not known whether interventions to control these variables would improve outcome.
  
  
  CONCLUSIONS
  Intraoperative hemodynamic abnormalities, including pulmonary hypertension, hypotension during cardiopulmonary bypass, and postcardiopulmonary bypass pulmonary diastolic hypertension, were independently associated with mortality, stroke, and perioperative myocardial infarction over and above the effects of other preoperative risk factors.
authors.affiliation: Department of Anesthesiology, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA. dreich@smtplink.mssm.edu
authors.forename: D L
authors.initials: DL
authors.lastname: Reich
authors.forename: C A
authors.initials: CA
authors.lastname: Bodian
authors.forename: M
authors.initials: M
authors.lastname: Krol
authors.forename: M
authors.initials: M
authors.lastname: Kuroda
authors.forename: T
authors.initials: T
authors.lastname: Osinski
authors.forename: D M
authors.initials: DM
authors.lastname: Thys
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001919:Bradycardia / Q000453:epidemiology; D002315:Cardiopulmonary Bypass; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D005544:Forecasting; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006751:Hospital Information Systems; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D016015:Logistic Models; D016347:Medical Records Systems, Computerized; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology*; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013610:Tachycardia / Q000453:epidemiology