title: Preoperative pulse pressure and major perioperative adverse cardiovascular outcomes after lower extremity vascular bypass surgery.
abstract: BACKGROUND
  Preoperative increased pulse pressure (PP) has been found to be a predictor of major adverse cardiovascular events (MACEs) after coronary artery bypass graft surgery. In this study, we evaluated the predictive ability of increased preoperative PP to identify MACEs in patients with peripheral vascular disease undergoing lower extremity vascular bypass surgery.
  
  
  METHODS
  We used the prospectively collected vascular surgery database at our institution to identify 412 consecutive patients who had lower extremity bypass surgery between January 2003 and December 2004. Preoperative demographics including comorbidities, medications, intraoperative characteristics, and postoperative MACE outcomes (myocardial infarction, congestive heart failure, stroke, and in-hospital mortality) were recorded. PP data as a continuous and categorical variable (PP <80 or ≥80 mm Hg) were tested for the ability to predict postoperative MACEs. A final parsimonious logistic regression was built to evaluate the predictive ability of PP.
  
  
  RESULTS
  MACEs occurred in 5.7% of patients in the PP <80 mm Hg group compared with 8.8% in the PP ≥80 mm Hg group (P = 0.229). Patients with MACEs were older (76 ± 10 years vs 68 ± 12 years; P = 0.001), had a history of myocardial infarction (9% vs 4%; P = 0.049), and had a preoperative PP of 75 ± 19 mm Hg vs 71 ± 21 mm Hg (P = 0.306). In the final logistic regression model, only age in years was a predictor of MACEs (odds ratio, 1.062; 95% confidence interval, 1.02-1.10; P = 0.02). There was no relationship between PP ≥80 mm Hg and risk for MACEs (odds ratio, 1.36; 95% confidence interval, 0.62-2.90; P = 0.44).
  
  
  CONCLUSIONS
  Preoperative increase in PP is not a predictor of adverse cardiovascular outcomes in patients having lower extremity revascularization surgery.
authors.affiliation: Department of Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Asopa
authors.forename: Srinivas
authors.initials: S
authors.lastname: Jidge
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.forename: Philip E
authors.initials: PE
authors.lastname: Hess
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.forename: Balachundhar
authors.initials: B
authors.lastname: Subramaniam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001900:Boston; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D016017:Odds Ratio; D059035:Perioperative Period; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality