Department of Anesthesiology, Columbia University Medical Center, New York, NY, United States of America.
Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, NY, United States of America.
Int J Cardiol. 2019 Mar 15;279:1-5. doi: 10.1016/j.ijcard.2018.12.032. Epub 2018 Dec 12.
Myocardial injury after non-cardiac surgery (MINS) is a common post-operative cardiovascular complication and is associated with short and long-term mortality. The objective of this study was to describe the contemporary management of patients with and without MINS after total joint and spine orthopedic surgery at a large urban health system in the United States.
Adults admitted for total joint and major spine surgery from January 2013 through December 2015 with ≥1 cardiac troponin (cTn) measurement during their hospitalization were identified. MINS was defined by a peak cTn above the 99th percentile of the upper reference limit. Demographics, medical comorbidities, and admission and discharge medications were reviewed for all patients.
A total of 2561 patients underwent 2798 orthopedic surgeries, and 236 cases of MINS were identified. Patients with MINS were older (71.9 ± 10.9 vs. 67.0 ± 10.0, p < 0.001) and more likely to have cardiovascular risk factors, including hypertension, chronic kidney disease, prior stroke, coronary artery disease, prior MI, and a history of heart failure. Among patients with MINS, only 112 (47.5%) were discharged on a combination of aspirin and statin. Patients with MINS were more likely to be prescribed a statin (154 [65.3%] vs. 1463 [57.1%], p = 0.018), beta-blocker (147 [62.3%] vs. 1194 [46.6%], p < 0.001), and oral anticoagulation (65 [27.5%] vs. 436 [17.0%], p < 0.001) than patients without MINS.
The proportion of patients with MINS who were prescribed medical therapy for atherosclerotic cardiovascular disease was low. Additional efforts to determine optimal management of MINS are warranted.
非心脏手术后心肌损伤（MINS）是一种常见的术后心血管并发症，与短期和长期死亡率相关。本研究的目的是描述在美国一家大型城市卫生系统中，接受全关节和脊柱矫形手术后伴有和不伴有 MINS 的患者的当代治疗方法。
从 2013 年 1 月至 2015 年 12 月期间，对因全关节和大脊柱手术入院的患者进行研究，患者在住院期间至少有 1 次肌钙蛋白（cTn）测量值。通过肌钙蛋白峰值超过参考上限第 99 百分位来定义 MINS。回顾所有患者的人口统计学、合并症、入院和出院时的药物治疗情况。
共 2561 例患者接受了 2798 例矫形手术，共发现 236 例 MINS。患有 MINS 的患者年龄更大（71.9±10.9 岁比 67.0±10.0 岁，p<0.001），且更可能存在心血管危险因素，包括高血压、慢性肾脏病、既往卒中、冠状动脉疾病、既往心肌梗死和心力衰竭史。在 MINS 患者中，仅 112 例（47.5%）出院时接受了阿司匹林和他汀类药物联合治疗。与无 MINS 患者相比，MINS 患者更可能被处方他汀类药物（154 例[65.3%]比 1463 例[57.1%]，p=0.018）、β受体阻滞剂（147 例[62.3%]比 1194 例[46.6%]，p<0.001）和口服抗凝剂（65 例[27.5%]比 436 例[17.0%]，p<0.001）。
患有 MINS 的患者接受动脉粥样硬化性心血管疾病治疗的比例较低。需要进一步努力确定 MINS 的最佳治疗方法。
