血管外科患者非心脏手术后心肌损伤（MINS）：一项前瞻性观察队列研究。

Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients: A Prospective Observational Cohort Study.

机构信息

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.

Leeds teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom.

出版信息

Ann Surg. 2018 Aug;268(2):357-363. doi: 10.1097/SLA.0000000000002290.

DOI:10.1097/SLA.0000000000002290

PMID:28486392

Abstract

OBJECTIVE

To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients.

BACKGROUND

MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described.

METHODS

This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring.

RESULTS

The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%-22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%-20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%-3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46-25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1-29.1) and without an ischemic feature (12.2%; 95% CI, 5.3-25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6-82.4).

CONCLUSIONS

Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.

摘要

目的

确定非心脏手术后心肌损伤（MINS）与血管外科患者的预后相关性、临床特征和 30 天结局。

背景

MINS 与非心脏手术后 30 天死亡率独立相关。血管外科患者 MINS 的特征和预后重要性描述较差。

方法

这是一项针对 15102 名 45 岁或以上非心脏手术患者的国际前瞻性队列研究，其中 502 名患者接受了血管手术。所有患者在术后第 1 至 3 天内均测量了第四代血浆肌钙蛋白 T（TnT）浓度。MINS 定义为 TnT 因缺血而升高至 0.03ng/ml 以上。本研究的目的是确定：（i）MINS 是否对血管外科患者具有预后意义；（ii）有和没有 MINS 的血管外科患者的临床特征；（iii）有和没有 MINS 的血管外科患者的 30 天结局；（iv）如果没有常规肌钙蛋白监测，MINS 可能会漏诊的比例。

结果

血管外科患者的 MINS 发生率为 19.1%（95%置信区间[CI]，15.7%-22.6%）。MINS 患者血管组 30 天全因死亡率为 12.5%（95%CI，7.3%-20.6%），而无 MINS 患者为 1.5%（95%CI，0.7%-3.2%）（P<0.001）。MINS 与血管患者 30 天死亡率独立相关（比值比，9.48；95%CI，3.46-25.96）。有和没有缺血特征的 MINS 患者的 30 天死亡率相似（15.0%；95%CI，7.1-29.1）（P=0.76）。无明显心肌缺血证据的血管外科患者中发生 MINS 的比例为 74.1%（95%CI，63.6-82.4）。