Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY; Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY.
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
Am J Cardiol. 2019 May 1;123(9):1532-1537. doi: 10.1016/j.amjcard.2019.02.006. Epub 2019 Feb 8.
Pulmonary hypertension (PH), defined by a mean pulmonary artery pressure of >25mm Hg at rest, is strongly associated with morbidity and mortality in the perioperative period. The prevalence and outcomes of PH among patients referred for major noncardiac surgery in the United States are unknown. Patients ≥18 years of age hospitalized for noncardiac surgery were identified from Healthcare Cost and Utilization Project's National Inpatient Sample data from 2004 to 2014. Pulmonary hypertension was defined by International Classification of Diseases, Ninth Revision diagnosis codes. The primary outcome was perioperative major adverse cardiovascular events (MACCE), defined as in-hospital death, myocardial infarction, or ischemic stroke. Among 17,853,194 hospitalizations for major noncardiac surgery, 143,846 (0.81%) had PH. MACCE occurred in 8.3% of hospitalizations with any diagnosis of PH in comparison to 2.0% of those without PH (p <0.001), driven by an increased frequency of death (4.4% vs 1.1%, p <0.001) and nonfatal myocardial infarction (3.2% vs 0.6%, p <0.001). After adjusting for demographics, clinical covariates, and surgery type, PH remained independently associated with MACCE (aOR 1.43, 95% CI 1.40 to 1.46). In conclusion, PH is associated with perioperative major adverse cardiovascular events. Careful patient selection, recognition of perioperative risks, and appropriate intraoperative hemodynamic monitoring may improve perioperative cardiovascular outcomes.
肺动脉高压（PH）定义为静息状态下平均肺动脉压>25mmHg，与围手术期发病率和死亡率密切相关。在美国，接受非心脏大手术的患者中 PH 的患病率和结局尚不清楚。本研究从 2004 年至 2014 年的医疗保健成本和利用项目国家住院患者样本数据中确定了因非心脏手术住院的年龄≥18 岁的患者。PH 通过国际疾病分类，第九版诊断代码来定义。主要结局是围手术期主要不良心血管事件（MACCE），定义为院内死亡、心肌梗死或缺血性卒中。在 17853194 例非心脏大手术住院患者中，有 143846 例（0.81%）患有 PH。患有任何 PH 诊断的住院患者的 MACCE 发生率为 8.3%，而无 PH 的住院患者为 2.0%（p<0.001），主要是由于死亡率（4.4%比 1.1%，p<0.001）和非致死性心肌梗死（3.2%比 0.6%，p<0.001）的发生率增加所致。在校正人口统计学、临床协变量和手术类型后，PH 与 MACCE 仍独立相关（调整优势比 1.43，95%置信区间 1.40 至 1.46）。总之，PH 与围手术期主要不良心血管事件相关。仔细的患者选择、识别围手术期风险和适当的术中血流动力学监测可能会改善围手术期心血管结局。
