Targeting higher intraoperative BP does not prevent postoperative MACE: Study
Switzerland: According to a recent study, universally targeting higher intraoperative blood pressures in patients at cardiovascular (CV) risk undergoing major noncardiac surgery may not reduce postoperative complications.
The study, published in the Journal of the American College of Cardiology (JACC) found that despite a 60% reduction in hypotensive time with MAP <65 mm Hg, there were no significant reductions in acute myocardial injury or 30-day major adverse cardiovascular events (MACE)/ acute kidney injury (AKI).
Intraoperative arterial hypotension is known to be strongly associated with postoperative MACE; however, it is not clear whether targeting higher intraoperative mean arterial blood pressures (MAPs) may prevent adverse events. Patrick M.Wanner, University Hospital Basel, Basel, Switzerland, and colleagues aimed to determine whether targeting higher intraoperative MAP lowers the incidence of postoperative MACE.
For this purpose, the researchers designed a single-center randomized controlled trial. It included adult patients at cardiovascular risk undergoing major noncardiac surgery. 458 patients were assigned to an intraoperative MAP target of ≥60 mm Hg (control) or ≥75 mm Hg (MAP ≥75).
The primary outcome was an acute myocardial injury on postoperative days 0-3 and/or 30-day MACE/acute kidney injury (AKI) (acute coronary syndrome, congestive heart failure, coronary revascularization, stroke, AKI, and all-cause mortality). The secondary outcome was 1-year MACE.
Key findings include:
- The cumulative intraoperative duration with MAP <65 mm Hg was significantly shorter in the MAP ≥75 group (median 9 minutes' vs 23 minutes).
- The primary outcome incidence was 48% for MAP ≥75 and 52% for control (risk difference −4.2%), the primary contributor being AKI (incidence 44%).
- Acute myocardial injury occurred in 15% (MAP ≥75) and 19% (control) of patients.
- The secondary outcome incidence was 17% for MAP ≥75 and 15% for control (risk difference +2.7).
"These findings do not support universally targeting higher intraoperative blood pressures to reduce postoperative complications," concluded the authors. "However, there is a need for further studies examining the interplay of intraoperative hypotension, perioperative hemodynamic intervention, and postoperative outcomes with a focus on individualization."
The study titled, "Targeting Higher Intraoperative Blood Pressures Does Not Reduce Adverse Cardiovascular Events Following Noncardiac Surgery," is published in the Journal of the American College of Cardiology (JACC).