Division of Cardiology, Department of Medicine, New York University School of Medicine, New York.
Department of Medicine, Medical College of Wisconsin, Milwaukee.
JAMA Cardiol. 2017 Feb 1;2(2):181-187. doi: 10.1001/jamacardio.2016.4792.
Major adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following noncardiac surgery.
To evaluate national trends in perioperative cardiovascular outcomes and mortality after major noncardiac surgery and to identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions.
DESIGN, SETTING, PARTICIPANTS: Patients who underwent major noncardiac surgery from January 2004 to December 2013 were identified using the National Inpatient Sample.
Perioperative MACCE (primary outcome), defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, were evaluated over time.
Among 10 581 621 hospitalizations (mean [SD] patient age, 65.74 [12.32] years; 5 975 798 female patients 56.60%]) for major noncardiac surgery, perioperative MACCE occurred in 317 479 hospitalizations (3.0%), corresponding to an annual incidence of approximately 150 000 events after applying sample weights. Major adverse cardiovascular and cerebrovascular events occurred most frequently in patients undergoing vascular (7.7%), thoracic (6.5%), and transplant surgery (6.3%). Between 2004 and 2013, the frequency of MACCE declined from 3.1% to 2.6% (P for trend <.001; adjusted odds ratio [aOR], 0.95; 95% CI, 0.94-0.97) driven by a decline in frequency of perioperative death (aOR, 0.79; 95% CI, 0.77-0.81) and AMI (aOR, 0.87; 95% CI, 0.84-0.89) but an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013 (P for trend <.001; aOR 1.79; CI 1.73-1.86).
Perioperative MACCE occurs in 1 of every 33 hospitalizations for noncardiac surgery. Despite reductions in the rate of death and AMI among patients undergoing major noncardiac surgery in the United States, perioperative ischemic stroke increased over time. Additional efforts are necessary to improve cardiovascular care in the perioperative period of patients undergoing noncardiac surgery.
非心脏手术后的主要心血管和脑血管不良事件（MACCE）是围手术期发病率和死亡率的重要来源。
使用美国医院入院行政数据库评估主要非心脏手术后围手术期心血管结局和死亡率的国家趋势，并确定与心血管事件相关的手术亚型。
设计、设置、参与者：从 2004 年 1 月至 2013 年 12 月，使用国家住院患者样本确定接受主要非心脏手术的患者。
评估围手术期 MACCE（主要结局），定义为院内全因死亡、急性心肌梗死（AMI）或急性缺血性卒中等。
在 10581621 例接受非心脏大手术的住院患者中（平均[SD]患者年龄为 65.74[12.32]岁；5975798 名女性患者占 56.60%），317479 例（3.0%）住院患者发生围手术期 MACCE，应用样本权重后，每年约发生 150000 例事件。血管（7.7%）、胸部（6.5%）和移植手术（6.3%）的患者中发生重大不良心血管和脑血管事件的频率最高。2004 年至 2013 年间，MACCE 的频率从 3.1%下降到 2.6%（趋势 P<.001；调整后比值比[OR]，0.95；95%CI，0.94-0.97），这主要归因于围手术期死亡率（OR，0.79；95%CI，0.77-0.81）和 AMI（OR，0.87；95%CI，0.84-0.89）频率下降，但围手术期缺血性卒中从 2004 年的 0.52%增加到 2013 年的 0.77%（趋势 P<.001；OR 1.79；95%CI 1.73-1.86）。
每 33 例非心脏手术住院患者中就有 1 例发生围手术期 MACCE。尽管美国接受非心脏大手术的患者的死亡率和 AMI 发生率有所下降，但围手术期缺血性卒中的发生率随着时间的推移而增加。需要进一步努力改善非心脏手术后患者围手术期的心血管护理。
