Correspondence  |   September 2020
Blood Pressure Components and Organ Injury: Reply
Author Notes
  • Cleveland Clinic, Cleveland, Ohio (D.I.S.). DS@OR.org
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • (Accepted for publication June 9, 2020. Published online first on July 9, 2020.)
    (Accepted for publication June 9, 2020. Published online first on July 9, 2020.)×
Article Information
Correspondence
Correspondence   |   September 2020
Blood Pressure Components and Organ Injury: Reply
Anesthesiology 9 2020, Vol.133, 675-677. doi:https://doi.org/10.1097/ALN.0000000000003451
Anesthesiology 9 2020, Vol.133, 675-677. doi:https://doi.org/10.1097/ALN.0000000000003451
Dr. Yonekura notes that we failed to exclude patients with potential nonischemic causes of troponin elevation, thus possibly including some patients who did not actually have myocardial injury after noncardiac surgery.1  It is likely that most patients who have troponin elevations and conditions that might falsely elevate troponin concentrations actually do have myocardial injury. Nonetheless, nonischemic causes should have been excluded from our analyses.2 
Had the purpose of our study been to determine the incidence of myocardial injury, it would be critical to include only patients with scheduled (not-for-cause) troponin screening. But that was not our purpose at all. Detection and ascertainment bias are therefore irrelevant to our analysis. Instead, we asked which blood pressure components best predicted myocardial injury. Because all four components were evaluated in each patient, there was no bias.