title: Interarm systolic blood pressure difference is associated with myocardial injury after noncardiac surgery.
abstract: BACKGROUND
  Myocardial injury after non-cardiac surgery (MINS) is closely related to increased cardiovascular mortality.
  
  
  OBJECTIVE
  To evaluate the relationship between MINS and interarm systolic blood pressure difference (IASBPD), which has previously been shown to correlate with the frequency of cardiovascular events and arterial arteriosclerotic processes.
  
  
  METHODS
  This observational, single-centre cohort study included 240 consecutive noncardiac surgery patients aged ≥ 45 years. Simultaneous blood pressure recordings were taken preoperatively and IASBPD was calculated. Patients' electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels were obtained for a period of three days postoperatively.
  
  
  RESULTS
  Postoperatively, 27 (11.3%) patients were found to have MINS when hscTnT ≥ 14 ng/L was taken as a cut-off value. IASBPD > 10 mm Hg was found in 44 (18.3%) patients. When IASBPD was accepted to be a continuous variable, there was a higher IASBPD value in the MINS group (9.4 ± 5.0 vs. 4.5 ± 3.8, p < 0.000). When patients were grouped as those having IASBPD > 10 mm Hg and those not, exaggerate IASBPD was found to be more frequent in patients developing MINS (16 [59.3%] vs. 28 [13.1%], respectively, p < 0.000). Multiple logistic regression analysis found IASBPD > 10 mm Hg to be independently associated with the development of MINS (OR: 30.82; CI: 9.14-103.98; p < 0.000). Receiver operating char-acteristic curve analysis showed that the optimal IASBPD cut-off value for predicting MINS was 11.5 mm Hg, with a sensitivity of 61.0% and specificity of 89.1% (AUC = 0.79; 95% CI 0.71-0.87).
  
  
  CONCLUSIONS
  Increased IASBPD is closely related to development of MINS. The preoperative measurement of blood pressure from both arms may be an important and easy to use clinical tool in determining cardiovascular risk.
authors.affiliation: Department of Cardiology, Okmeydani Training and Research Hospital, Istanbul, Turkey. belenerdal@gmail.com.
authors.forename: Erdal
authors.initials: E
authors.lastname: Belen
authors.forename: Ender
authors.initials: E
authors.lastname: Ozal
authors.forename: Akif
authors.initials: A
authors.lastname: Bayyigit
authors.forename: Senay
authors.initials: S
authors.lastname: Gunaydın
authors.forename: Aysen
authors.initials: A
authors.lastname: Helvacı
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
keywords: interarm systolic blood pressure difference; myocardial injury; noncardiac surgery