Mazankowski Alberta Heart Institute, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada.
Circulation. 2011 Jul 19;124(3):289-96. doi: 10.1161/CIRCULATIONAHA.110.011130. Epub 2011 Jun 27.
The postoperative risks for patients with coronary artery disease (CAD) undergoing noncardiac surgery are well described. However, the risks of noncardiac surgery in patients with heart failure (HF) and atrial fibrillation (AF) are less well known. The purpose of this study is to compare the postoperative mortality of patients with HF, AF, or CAD undergoing major and minor noncardiac surgery.
Population-based data were used to create 4 cohorts of consecutive patients with either nonischemic HF (NIHF; n=7700), ischemic HF (IHF; n=12 249), CAD (n=13 786), or AF (n=4312) who underwent noncardiac surgery between April 1, 1999, and September 31, 2006, in Alberta, Canada. The main outcome was 30-day postoperative mortality. The unadjusted 30-day postoperative mortality was 9.3% in NIHF, 9.2% in IHF, 2.9% in CAD, and 6.4% in AF (each versus CAD, P<0.0001). Among patients undergoing minor surgical procedures, the 30-day postoperative mortality was 8.5% in NIHF, 8.1% in IHF, 2.3% in CAD, and 5.7% in AF (P<0.0001). After multivariable adjustment, postoperative mortality remained higher in NIHF, IHF, and AF patients than in those with CAD (NIHF versus CAD: odds ratio 2.92; 95% confidence interval 2.44 to 3.48; IHF versus CAD: odds ratio 1.98; 95% confidence interval 1.70 to 2.31; AF versus CAD: odds ratio 1.69; 95% confidence interval 1.34 to 2.14).
Although current perioperative risk prediction models place greater emphasis on CAD than HF or AF, patients with HF or AF have a significantly higher risk of postoperative mortality than patients with CAD, and even minor procedures carry a risk higher than previously appreciated.
患有冠状动脉疾病（CAD）的患者接受非心脏手术的术后风险已有详细描述。然而，心力衰竭（HF）和心房颤动（AF）患者接受非心脏手术的风险则知之甚少。本研究的目的是比较行大、小非心脏手术后 HF、AF 或 CAD 患者的术后死亡率。
利用基于人群的数据，创建了 4 个连续队列的患者，这些患者要么患有非缺血性 HF（NIHF；n=7700），要么患有缺血性 HF（IHF；n=12249）、CAD（n=13786）或 AF（n=4312），他们在 1999 年 4 月 1 日至 2006 年 9 月 31 日期间在加拿大艾伯塔省接受非心脏手术。主要结果是 30 天术后死亡率。未校正的 NIHF、IHF、CAD 和 AF 患者的 30 天术后死亡率分别为 9.3%、9.2%、2.9%和 6.4%（每个与 CAD 相比，P<0.0001）。在接受小手术的患者中，NIHF、IHF、CAD 和 AF 患者的 30 天术后死亡率分别为 8.5%、8.1%、2.3%和 5.7%（P<0.0001）。经过多变量校正后，NIHF、IHF 和 AF 患者的术后死亡率仍高于 CAD 患者（NIHF 与 CAD 相比：比值比 2.92；95%置信区间 2.44 至 3.48；IHF 与 CAD 相比：比值比 1.98；95%置信区间 1.70 至 2.31；AF 与 CAD 相比：比值比 1.69；95%置信区间 1.34 至 2.14）。
尽管当前的围手术期风险预测模型更强调 CAD 而不是 HF 或 AF，但 HF 或 AF 患者的术后死亡率明显高于 CAD 患者，即使是小手术也比之前认为的风险更高。
