Department of Medicine, Mount Sinai St Luke's and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Rheumatology and Immunology, China PLA General Hospital, Beijing, China.
Int J Rheum Dis. 2019 Jun;22(6):1023-1028. doi: 10.1111/1756-185X.13537. Epub 2019 Mar 4.
We investigated the association between systemic sclerosis (SSc) and perioperative cardiovascular risk for inpatient non-cardiac surgical procedures.
We used data from the National Inpatient Sample (NIS) for the year 2014 to identify patients undergoing inpatient non-cardiac surgery. SSc and major adverse cardiovascular events (MACE) were defined by International Classification of Diseases 9th Revision diagnosis codes. Univariate and multivariate analyses were performed. We adjusted for demographic information, socioeconomic status, cardiac comorbidities, cardiovascular risk factors and procedural category. Two models were used with different categorization strategies for surgical procedures.
A total of 8 156 379 hospitalizations for non-cardiac surgeries were included, 4385 of which had a diagnosis of SSc. Patients with SSc were older, more likely to be female and Caucasian and with higher cardiac and systemic comorbidity burden. In univariate analysis, SSc was associated with higher risk of perioperative MACE (odds ratio [OR] = 2.9; P < 0.001) and all-cause death (P = 3.07; P < 0.001). Multivariate analysis yielded conflicting results regarding the association between SSc and perioperative MACE (Model 1: OR = 1.42; P = 0.146; Model 2: OR = 1.59; P = 0.048). Subsequent analysis showed that only perioperative myocardial infarction (Model 1 OR = 1.85; P = 0.048; Model 2 OR = 1.94; P = 0.031) was independently associated with SSc.
We did not find consistent association between SSc and perioperative MACE in non-cardiac surgical procedures. SSc may be associated with perioperative myocardial infarction.
我们研究了系统性硬化症（SSc）与住院非心脏手术围手术期心血管风险的关系。
我们使用 2014 年国家住院患者样本（NIS）的数据来确定接受住院非心脏手术的患者。SSc 和主要不良心血管事件（MACE）通过国际疾病分类第 9 版诊断代码定义。进行了单变量和多变量分析。我们调整了人口统计学信息、社会经济状况、心脏合并症、心血管危险因素和手术类别。使用两种模型，手术类别采用不同的分类策略。
共纳入 8156379 例非心脏手术住院患者，其中 4385 例诊断为 SSc。SSc 患者年龄较大，更可能为女性和白种人，且心脏和全身合并症负担更高。在单变量分析中，SSc 与围手术期 MACE（优势比 [OR] = 2.9；P < 0.001）和全因死亡（P = 3.07；P < 0.001）风险增加相关。多变量分析得出的结果在 SSc 与围手术期 MACE 之间的关系上存在差异（模型 1：OR = 1.42；P = 0.146；模型 2：OR = 1.59；P = 0.048）。进一步分析表明，只有围手术期心肌梗死（模型 1 OR = 1.85；P = 0.048；模型 2 OR = 1.94；P = 0.031）与 SSc 独立相关。
我们没有发现 SSc 与非心脏手术围手术期 MACE 之间存在一致的关联。SSc 可能与围手术期心肌梗死有关。
