Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, People's Republic of China.
Peking Union Medical College, School of Clinical Medicine, Beijing, People's Republic of China.
J Arthroplasty. 2018 Jan;33(1):235-240. doi: 10.1016/j.arth.2017.08.011. Epub 2017 Aug 31.
Although coronary artery revascularization therapies are effective for treating coronary artery disease (CAD), these patients may be more susceptible to adverse cardiac events during later non-cardiac surgeries. The purpose of this study is to evaluate post-operative 90-day complications of total joint arthroplasty (TJA) in CAD patients with a history of CAD and to study the risk factors for cardiac complications.
We performed a retrospective analysis of TJA patients between 2005 and 2015 at our institute by summarizing the history of CAD, cardiac revascularization, and cardiac complications within 90 days after the operation. Multivariate logistic regression was performed to identify the factors that predicted cardiac complications within 90 days after the operation.
A total of 4414 patients were included; of these, 64 underwent cardiac revascularization and 201 CAD patients underwent medical therapy other than revascularization. All the revascularization had history of myocardial infarction (MI). The rate of cardiac complications within 90 days for the CAD with revascularization was 18.7%, 18.4% for the CAD without revascularization, and 2.0% for the non-CAD group. A history of CAD and revascularization, bilateral TJA, general anesthesia, body mass index ≥30 kg/m, and history of MI were associated with a higher risk of cardiac complications. Patients who underwent TJA within 2 years after cardiac revascularization had a significantly higher cardiac complication rate, and the risk decreased with time.
There is an increased risk of cardiac complications within 90 days after the operation among TJA patients with a history of CAD. Revascularization cannot significantly reduce the risk of cardiac complications after TJA for CAD patients. However, the risk decreased as the interval between revascularization and TJA increased.
尽管冠状动脉血运重建治疗对治疗冠状动脉疾病（CAD）有效，但这些患者在以后的非心脏手术中可能更容易发生不良心脏事件。本研究旨在评估有 CAD 病史的 CAD 患者行全关节置换术（TJA）后的 90 天内并发症，并研究心脏并发症的危险因素。
通过总结手术 90 天内 CAD 病史、心脏血运重建和心脏并发症的病史，我们对 2005 年至 2015 年在我院行 TJA 的患者进行了回顾性分析。采用多变量逻辑回归分析确定术后 90 天内预测心脏并发症的因素。
共纳入 4414 例患者；其中 64 例行心脏血运重建，201 例 CAD 患者行非血运重建的药物治疗。所有血运重建均有心肌梗死（MI）病史。有血运重建的 CAD 患者术后 90 天内心脏并发症发生率为 18.7%，无血运重建的 CAD 患者为 18.4%，非 CAD 组为 2.0%。CAD 病史和血运重建、双侧 TJA、全身麻醉、BMI≥30kg/m2和 MI 史与心脏并发症风险增加相关。心脏血运重建后 2 年内行 TJA 的患者心脏并发症发生率显著升高，且风险随时间降低。
有 CAD 病史的 TJA 患者术后 90 天内发生心脏并发症的风险增加。血运重建并不能显著降低 CAD 患者 TJA 后心脏并发症的风险。但随着血运重建与 TJA 之间间隔时间的延长，风险降低。
