Valadkhani A, Gupta A, Cauli G, et al.
Anesthesia & Analgesia, Vol. 141(1): 5–15, July 2025
DOI: 10.1213/ANE.0000000000007379
Summary:
This prospective, single-center study evaluated how various intraoperative hypotension (IOH) thresholds relate to perioperative myocardial injury (PMI) in vascular surgery patients. Using high-frequency invasive blood pressure data and a white-box machine learning model, the study identified that absolute diastolic arterial pressure (DAP) under 44 mm Hg was the most reliable predictor of PMI. Systolic and mean pressures, as well as tachycardia, showed weaker or no association.
Important findings:
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Sample size: 498 patients; 99 (20%) experienced PMI
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Troponin T measured preoperatively and at 4, 24, and 48 hours post-op
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Monitoring: arterial pressure and heart rate measured every 15 seconds
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Best predictor: absolute diastolic arterial pressure <44 mm Hg
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Systolic, mean arterial pressure, and relative thresholds were less predictive
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No significant correlation found between tachycardia and PMI
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Model performance:
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Macro average F1 score: 0.67
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Weighted average F1 score: 0.76
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Conclusions:
An absolute threshold of diastolic pressure below 44 mm Hg was the most accurate intraoperative indicator of PMI, outperforming other blood pressure measures and heart rate metrics.
KEY POINTS
- Question: Which threshold for intraoperative hypotension and tachycardia best predicts perioperative myocardial injury (PMI)?
- Findings: In this explorative prospective observational trial in patients undergoing vascular surgery, we found that an absolute, not relative, threshold for intraoperative hypotension based on diastolic, and not systolic or mean arterial pressure, was most predictive of PMI.
- Meaning: Previous studies have established a relationship between mean arterial pressure and PMI; however, our findings suggest that diastolic pressure might be more predictive of PMI.
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Devereaux PJ, Biccard BM, Sigamani A, et al. JAMA. 2017;317:1642–1651.
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