A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury After Noncardiac Surgery: Results of the VISION Study

<jats:sec> <jats:title>BACKGROUND:</jats:title> <jats:p>The association between intraoperative cardiovascular changes and perioperative myocardial injury has chiefly focused on hypotension during noncardiac surgery. However, the relative influence of blood pressure and heart rate (HR) remains unclear. We investigated both individual and codependent relationships among intraoperative HR, systolic blood pressure (SBP), and myocardial injury after noncardiac surgery (MINS).</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS:</jats:title> <jats:p>Secondary analysis of the Vascular Events in Noncardiac Surgery Cohort Evaluation (VISION) study, a prospective international cohort study of noncardiac surgical patients. Multivariable logistic regression analysis tested for associations between intraoperative HR and/or SBP and MINS, defined by an elevated serum troponin T adjudicated as due to an ischemic etiology, within 30 days after surgery. Predefined thresholds for intraoperative HR and SBP were: maximum HR >100 beats or minimum HR <55 beats per minute (bpm); maximum SBP >160 mm Hg or minimum SBP <100 mm Hg. Secondary outcomes were myocardial infarction and mortality within 30 days after surgery.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS:</jats:title> <jats:p>After excluding missing data, 1197 of 15,109 patients (7.9%) sustained MINS, 454 of 16,031 (2.8%) sustained myocardial infarction, and 315 of 16,061 patients (2.0%) died within 30 days after surgery. Maximum intraoperative HR >100 bpm was associated with MINS (odds ratio [OR], 1.27 [1.07–1.50]; <jats:italic toggle="yes">P</jats:italic> < .01), myocardial infarction (OR, 1.34 [1.05–1.70]; <jats:italic toggle="yes">P</jats:italic> = .02), and mortality (OR, 2.65 [2.06–3.41]; <jats:italic toggle="yes">P</jats:italic> < .01). Minimum SBP <100 mm Hg was associated with MINS (OR, 1.21 [1.05–1.39]; <jats:italic toggle="yes">P</jats:italic> = .01) and mortality (OR, 1.81 [1.39–2.37]; <jats:italic toggle="yes">P</jats:italic> < .01), but not myocardial infarction (OR, 1.21 [0.98–1.49]; <jats:italic toggle="yes">P</jats:italic> = .07). Maximum SBP >160 mm Hg was associated with MINS (OR, 1.16 [1.01–1.34]; <jats:italic toggle="yes">P</jats:italic> = .04) and myocardial infarction (OR, 1.34 [1.09–1.64]; <jats:italic toggle="yes">P</jats:italic> = .01) but, paradoxically, reduced mortality (OR, 0.76 [0.58–0.99]; <jats:italic toggle="yes">P</jats:italic> = .04). Minimum HR <55 bpm was associated with reduced MINS (OR, 0.70 [0.59–0.82]; <jats:italic toggle="yes">P</jats:italic> < .01), myocardial infarction (OR, 0.75 [0.58–0.97]; <jats:italic toggle="yes">P</jats:italic> = .03), and mortality (OR, 0.58 [0.41–0.81]; <jats:italic toggle="yes">P</jats:italic> < .01). Minimum SBP <100 mm Hg with maximum HR >100 bpm was more strongly associated with MINS (OR, 1.42 [1.15–1.76]; <jats:italic toggle="yes">P</jats:italic> < .01) compared with minimum SBP <100 mm Hg alone (OR, 1.20 [1.03–1.40]; <jats:italic toggle="yes">P</jats:italic> = .02).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS:</jats:title> <jats:p>Intraoperative tachycardia and hypotension are associated with MINS. Further interventional research targeting HR/blood pressure is needed to define the optimum strategy to reduce MINS.</jats:p> </jats:sec>