Armstrong Ehrin J, Graham Laura, Waldo Stephen W, Valle Javier A, Maddox Thomas M, Hawn Mary T
Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
Birmingham Veterans Administration Hospital, Birmingham, Alabama.
Catheter Cardiovasc Interv. 2017 Mar 1;89(4):617-627. doi: 10.1002/ccd.26624. Epub 2016 Jun 17.
To identify predictors of major adverse cardiovascular outcomes (MACE) among patients with prior percutaneous coronary intervention (PCI) who require noncardiac surgery.
Patients with prior PCI who undergo noncardiac surgery have an increased risk of postoperative MACE, but few studies have examined the association of PCI lesion characteristics with subsequent operative risk.
Patients were identified using the VA Clinical Assessment, Reporting, and Tracking (CART) program. Patients who underwent noncardiac surgery within 2 years after stent placement were linked to VA and non-VA surgical records. A multivariable logistic regression model was developed to identify predictors of postoperative MACE.
Among 12,621 patients with a history of prior PCI who underwent subsequent noncardiac surgery, 570 (4.5%) developed postoperative MACE. The median time from stent placement to surgery was 368 days (IQR 181-528). The strongest predictors of postoperative MACE were urgency of the operation, revised cardiac risk index, the indication for the prior PCI, and timing of the surgery after the PCI. Lesion characteristics independently associated with postoperative MACE included PCI to a distal (AOR 1.43, 95% CI 1.11-1.83) or ostial lesion (AOR 1.52, 95% CI 1.11-2.08), and lesion calcification (AOR 1.29, 95% CI 1.03-1.61), but stent length and target vessel were not independently associated with outcomes. Placement of a bare metal stent was also an independent predictor of MACE after noncardiac surgery (AOR 1.29, 95% CI 1.06-1.57).
While patient and operative characteristics are the strongest predictors of MACE after noncardiac surgery, specific lesion characteristics including ostial or distal lesion location and calcification are novel risk factors for postoperative MACE. © 2016 Wiley Periodicals, Inc.
确定需要接受非心脏手术的既往经皮冠状动脉介入治疗（PCI）患者发生主要不良心血管事件（MACE）的预测因素。
接受非心脏手术的既往PCI患者术后发生MACE的风险增加，但很少有研究探讨PCI病变特征与后续手术风险之间的关联。
通过退伍军人事务部临床评估、报告和跟踪（CART）计划识别患者。在支架置入后2年内接受非心脏手术的患者与退伍军人事务部和非退伍军人事务部的手术记录相关联。建立多变量逻辑回归模型以识别术后MACE的预测因素。
在12621例有既往PCI病史并随后接受非心脏手术的患者中，570例（4.5%）发生了术后MACE。从支架置入到手术的中位时间为368天（四分位间距181 - 528天）。术后MACE的最强预测因素是手术的紧迫性、修订的心脏风险指数、既往PCI的指征以及PCI后手术的时间。与术后MACE独立相关的病变特征包括远端（比值比[AOR]1.43，95%置信区间[CI]1.11 - 1.83）或开口处病变（AOR 1.52，95% CI 1.11 - 2.08）以及病变钙化（AOR 1.29，95% CI 1.03 - 1.61），但支架长度和靶血管与结局无独立关联。裸金属支架置入也是非心脏手术后MACE的独立预测因素（AOR 1.29，95% CI 1.06 - 1.57）。
虽然患者和手术特征是非心脏手术后MACE的最强预测因素，但特定的病变特征，包括开口处或远端病变位置以及钙化，是术后MACE的新危险因素。© 2016威利期刊公司
