Ollila A, Vikatmaa L, Virolainen J, Vikatmaa P, Leppäniemi A, Albäck A, Salmenperä M, Pettilä V
1 Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
2 Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Scand J Surg. 2017 Jun;106(2):180-186. doi: 10.1177/1457496916673585. Epub 2016 Oct 13.
Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials.
We conducted a prospective single-center study on non-cardiac surgery patients aged 50 years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment.
Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery-19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non-perioperative myocardial infarction patients ( p < 0.001). Perioperative risk calculator predicted perioperative myocardial infarction with an area under curve of 0.73 (95% confidence interval: 0.64-0.81).
Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.
围手术期心肌梗死是一种诊断不足的并发症，可导致发病、死亡，并产生可观的费用。然而，关于预防和治疗方案的证据却很少。我们调查了非心脏手术患者围手术期心肌梗死的发生率和转归，以便确定未来干预试验的目标人群。
我们对50岁及以上的非心脏手术患者进行了一项前瞻性单中心研究。围手术期共5次检测高敏肌钙蛋白T和心电图。围手术期心肌梗死的诊断需要肌钙蛋白T显著升高以及缺血体征或症状。使用围手术期风险计算器进行风险评估。
在385例接受系统性缺血筛查的患者中，27例（7.0%）发生围手术期心肌梗死。血管外科手术患者的发生率最高——172例患者中有19例（11.0%）。围手术期心肌梗死患者的90天死亡率为29.6%，非围手术期心肌梗死患者为5.6%（p < 0.001）。围手术期风险计算器预测围手术期心肌梗死的曲线下面积为0.73（95%置信区间：0.64 - 0.81）。
围手术期心肌梗死是一种常见并发症，90天死亡率为30%。围手术期风险计算器预测围手术期心肌梗死的能力尚可，支持其常规使用。
