ISSN 2149-2263 | E-ISSN 2149-2271
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The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery [Anatol J Cardiol]
Anatol J Cardiol. 2008; 8(5): 354-359

The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery

Muzaffer Bahçivan1, Okan Gülel2, Fersat Kolbakır1
1From Departments of Cardiovascular Surgery, Ondokuz Mayıs University, Samsun, Turkey
2Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey

Objective: The aim of this prospective study was to evaluate the relationship between preoperative circadian blood pressure pattern and early postoperative course in patients undergoing coronary artery bypass graft (CABG) surgery.
Methods: One hundred and thirty patients planning to undergo isolated CABG operation were included to the study (80 men; 50 women). All patients were studied with ambulatory blood pressure monitoring performed 24 hours before surgery and were divided into 2 groups according with presence (79 patients) or absence (51 patients) of dipper phenomenon. Non-dippers were defined as those with a nocturnal reduction of systolic and diastolic blood pressures of less than 10% of daytime pressures. Both groups were compared with each other from the aspect of postoperative need for intraaortic balloon counterpulsation (IABP), inotropic drug support, extubation time, length of intensive care unit and hospitalization stays, renal failure, stroke, malignant ventricular arrhythmia, atrial fibrillation, postoperative myocardial infarction and cardiac mortality. Statistical analyses were performed using Chi-square, unpaired t and Mann-Whitney U tests. Logistic regression analysis was performed to establish associations of non-dipper phenomenon with the risk of postoperative complications.
Results: When compared with the dipper patients, need for inotropic medications (37.5% vs. 62.5%), low cardiac output syndrome (30.4% vs. 69.6%), postoperative myocardial infarction (28.6% vs. 71.4%) and malignant ventricular arrhythmias (27.8% vs. 72.2%) were higher in the non-dipper patients (p<0.05 for all). Logistic regression analysis demonstrated that non-dipper phenomenon after CABG was associated with longer cardiopulmonary bypass time (OR=1.038, 95%CI 1.016-1,060, p=0.001), more need for postoperative inotropic agent (OR=4.014, 95%CI 1.235-13,047, p=0.021) and postoperative IABP (OR=6.625, 95%CI 1.564-28.069, p=0.01) support, higher risk of low cardiac output syndrome (OR=4.159, 95%CI 0.921-18.775, p=0.064), malignant ventricular arrhythmia (OR=4.653, 95%CI 0.964-22,456, p=0.056) and postoperative myocardial infarction (OR=7.629, 95%CI 1.448-40.177, p=0.017).
Conclusion: Dipper and non-dipper phenomenon can be used as a simple analysis tool for assessing early postoperative mortality and morbidity.

Keywords: Dipper, non-dipper, ambulatory blood pressure monitoring, coronary artery bypass surgery, hypertension, morbidity, logistic regression analysis

Koroner arter baypas operasyonlu hastalarda preoperatif sirkadiyan kan basıncı paterninin erken postoperatif seyir üzerindeki etkisi

Muzaffer Bahçivan1, Okan Gülel2, Fersat Kolbakır1
1From Departments of Cardiovascular Surgery, Ondokuz Mayıs University, Samsun, Turkey
2Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey

Amaç: Bu prospektif çalışmanın amacı koroner arter baypas greftleme (KABG) operasyonu olan hastalarda, preoperatif sirkadiyan kan basıncı paterninin erken postoperatif seyir üzerindeki etkisini araştırmaktır.
Yöntemler: İzole KABG operasyonu planlanan 130 hasta (80 erkek, 50 kadın) çalışmaya dâhil edildi. Bütün hastalarda operasyondan 24 saat önce kan basıncı ölçümleri yapıldı ve hastalar dipper (79 hasta) ve non-dipper (51 hasta) fenomenin varlığına göre 2 gruba ayrıldı. Gecelik sistolik ve diyastolik kan basıncı değerleri %10’dan daha az düzen hasta grubu non-dipper olarak tanımlandı. Her iki grup postoperatif intraaortik balon pompas› (IABP) ihtiyacı, inotrop ilaç ihtiyacı, ekstübasyon zamanı, yoğun bakımda ve hastanede kalış süresi, renal yetersizlik, inme, malign ventriküler aritmi, atriyal fibrilasyon, düşük kardiyak debi sendromu, postoperatif miyokard infarktüsü ve mortalite açısından karşılaştırıldı. İstatistiksel değerlendirmede Ki-kare, eşleştirilmemiş t ve Mann Whitney U testleri kullanıldı. Non-dipper fenomeni ile postoperatif komplikasyon riskleri lojistik regresyon analizi yapılarak araştırıldı.
Bulgular: Dipper karakter gösteren hastalarla karşılaştırıldığında, non-dipper grupta inotropik ilaç ihtiyacı (%37.5’a %62.5), düşük kardiyak debi sendromu (%30.4’a %69.6), postoperatif miyokard infarktüsü (%28.6’e %71.4) ve malign ventriküler aritmiler (%27.8’e %72.2) daha fazlaydı (p<0.05). Lojistik regresyon analizinde sonuçlar şu şekildeydi; kardiyopulmoner baypas zamanı (OR=1.038, %95GA 1.016-1.060 p=0.001), postoperatif inotropik ajan ihtiyacı (OR=4.014, %95GA 1.235-13.047, p=0.021), düşük kardiyak debi sendromu (OR=4.159, %95GA 0.921-18.775, p=0.064), malign ventriküler aritmi (OR=4.653, %95GA 0.964-22.456, p=0.056) postoperatif IABP ihtiyacı (OR=6.625, p=0.010, %95GA(1.564-28.069), postoperatif miyokard infarktüsü (OR=7.629, %95GA 1.448-40.177, p=0.017).
Sonuç: Dipper ve non-dipper fenomen, KABG operasyonu geçirecek hastalarda erken postoperatif mortalite ve morbiditeyi tayin etmede basit bir analiz yöntemi olabilir.

Anahtar Kelimeler: Dipper, non-dipper, ambulatuvar kan basıncı monitarizasyonu, koroner arter baypas cerrahisi, hipertansiyon, morbidite, lojistik regresyon analizi

Muzaffer Bahçivan, Okan Gülel, Fersat Kolbakır. The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. Anatol J Cardiol. 2008; 8(5): 354-359

Corresponding Author: Muzaffer Bahçivan, Türkiye
Manuscript Language: English


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