We are more than happy to answer the questions Schulthess et al.1  have, based on our previous publication.2  The first question was to provide baseline characteristics of patients with and without myocardial injury. Their second question was related to the exposure and the associated risk for myocardial injury. Schulthess et al. are correct that duration under a mean arterial pressure (MAP) threshold of 75 mmHg is only associated with myocardial injury for prolonged periods of time. To graphically represent the relation between length of hypotension and myocardial injury, we could have chosen a MAP target of 60 mmHg where all durations, above 1 h, show an increased risk for myocardial injury. However, we have specifically chosen to report the highest threshold because this threshold was selected based on the figure in the supplemental digital content of the original article. Furthermore, we believe this threshold is relevant because the amount of time that was associated with myocardial injury (greater than 10 h) can be easily reached during the first postoperative night. The final question was with regard to certain preoperative medication and the risk of confounding. In our analysis we used the widely accepted rule of 10 events per variable to prevent imprecise and biased estimates in the logistic regression analysis. We therefore chose to adjust for the variables mostly associated with myocardial injury or hypotension. Sensitivity analysis including adjustment for the preoperative cardiovascular medication showed marginal differences in our results. Please find all the requested analysis in the tables 1–3.

Table 1.

Baseline and Perioperative Characteristics of High-dependency Ward Patients, Stratified for Myocardial Injury

Baseline and Perioperative Characteristics of High-dependency Ward Patients, Stratified for Myocardial Injury
Baseline and Perioperative Characteristics of High-dependency Ward Patients, Stratified for Myocardial Injury
Table 2.

Univariate and Multivariate Associations of Postoperative Hypotension, Defined as Different Exposures, and Myocardial Injury

Univariate and Multivariate Associations of Postoperative Hypotension, Defined as Different Exposures, and Myocardial Injury
Univariate and Multivariate Associations of Postoperative Hypotension, Defined as Different Exposures, and Myocardial Injury
Table 3.

Association of Postoperative Hypotension, as Duration under Multiple MAP Thresholds, and Myocardial Injury

Association of Postoperative Hypotension, as Duration under Multiple MAP Thresholds, and Myocardial Injury
Association of Postoperative Hypotension, as Duration under Multiple MAP Thresholds, and Myocardial Injury

The authors declare no competing interests.

1.
Schulthess
D
,
Amrein
M
,
Glarner
N
,
Lopez-Ayala
P
,
Mueller
C
: Postoperative hypotension and myocardial injury: Comment.
Anesthesiology
.
2021
;
134
:
503
4
2.
Liem
VGB
,
Hoeks
SE
,
Mol
KHJM
,
Potters
JW
,
Grüne
F
,
Stolker
RJ
,
van Lier
F
:
Postoperative hypotension after noncardiac surgery and the association with myocardial injury.
Anesthesiology
.
2020
;
133
:
510
22