1 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands.
2 Department of Cardiology, University Medical Center Utrecht, Utrecht University, The Netherlands.
Eur J Prev Cardiol. 2019 Jan;26(1):59-67. doi: 10.1177/2047487318798925. Epub 2018 Sep 12.
Over the past few years non-cardiac surgery has been recognised as a serious circulatory stress test which may trigger cardiovascular events such as myocardial infarction, in particular in patients at high risk. Detection of these postoperative cardiovascular events is difficult as clinical symptoms often go unnoticed. To improve detection, guidelines advise to perform routine postoperative assessment of cardiac troponin. Troponin elevation - or postoperative myocardial injury - can be caused by myocardial infarction. However, also non-coronary causes, such as cardiac arrhythmias, sepsis and pulmonary embolism, may play a role in a considerable number of patients with postoperative myocardial injury. It is crucial to acquire more knowledge about the underlying mechanisms of postoperative myocardial injury because effective prevention and treatment options are lacking. Preoperative administration of beta-blockers, aspirin, statins, clonidine, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and preoperative revascularisation have all been investigated as preventive options. Of these, only statins should be considered as the initiation or reload of statins may reduce the risk of postoperative myocardial injury. There is also not enough evidence for intraoperative measures such blood pressure optimisation or intensified medical therapy once patients have developed postoperative myocardial injury. Given the impact, better preoperative identification of patients at risk of postoperative myocardial injury, for example using preoperatively measured biomarkers, would be helpful to improve cardiac optimisation.
在过去的几年中，非心脏手术已被认为是一种严重的循环应激测试，可能会引发心血管事件，如心肌梗死，尤其是在高风险患者中。由于术后心血管事件的临床症状常常被忽视，因此很难发现这些事件。为了提高检测率，指南建议对心脏肌钙蛋白进行常规术后评估。肌钙蛋白升高——或术后心肌损伤——可能由心肌梗死引起。然而，心脏心律失常、败血症和肺栓塞等非冠状动脉原因也可能在相当数量的术后心肌损伤患者中发挥作用。了解术后心肌损伤的潜在机制至关重要，因为目前缺乏有效的预防和治疗选择。术前给予β受体阻滞剂、阿司匹林、他汀类药物、可乐定、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂以及术前血运重建术已被作为预防措施进行了研究。其中，只有他汀类药物应被视为考虑因素，因为他汀类药物的起始或再负荷治疗可能会降低术后心肌损伤的风险。对于术中措施，如血压优化或一旦患者发生术后心肌损伤就加强药物治疗，目前还没有足够的证据支持。鉴于其影响，如果能够更好地在术前识别出有术后心肌损伤风险的患者，例如使用术前测量的生物标志物，将有助于改善心脏优化。
