From the Lilibeth Caberto London Kidney Clinical Research Unit, London Health Sciences Centre, London, Canada (P.S.R.) the Department of Medicine (P.S.R., T.S., E.D., V.T., P.J.D.) Department of Health Research Methods, Evidence and Impact (P.S.R., E.D., P.J.D.), McMaster University, Hamilton, Canada the Population Health Research Institute, Hamilton, Canada (E.D., P.J.D.) the Division of General Internal Medicine, McGill University Health Center, Montreal, Canada (A.B.) the Department of Anesthesia and Intensive Care, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China (M.T.V.C.) the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (C.B.) the Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada (B.J.W.C.) the Department of Radiology, University of Ottawa, Ottawa, Canada (B.J.W.C.) the Department of Anesthesia, University of Toronto, Toronto, Canada (J.S.K).
Anesthesiology. 2019 May;130(5):756-766. doi: 10.1097/ALN.0000000000002654.
Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery. It is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension.
In this retrospective exploratory analysis of a substudy of an international prospective blinded cohort study, 955 patients 45 yr of age or older with history or risk factors for coronary artery disease underwent coronary computed tomographic angiography before elective inpatient noncardiac surgery. The authors evaluated the potential interaction between angiographic findings and perioperative hypotension (defined as systolic blood pressure less than 90 mmHg for a total of 10 min or more during surgery or for any duration after surgery and for which intervention was initiated) on the composite outcome of time to myocardial infarction or cardiovascular death up to 30 days after surgery. Angiography assessors were blinded to study outcomes; patients, treating clinicians, and outcome assessors were blinded to angiography findings.
Cardiovascular events (myocardial infarction or cardiovascular death within 30 days after surgery) occurred in 7.7% of patients (74/955), including in 2.7% (8/293) without obstructive coronary disease or hypotension compared to 6.7% (21/314) with obstructive coronary disease but no hypotension (hazard ratio, 2.51; 95% CI, 1.11 to 5.66; P = 0.027), 8.8% (14/159) in patients with hypotension but without obstructive coronary disease (hazard ratio, 3.85; 95% CI, 1.62 to 9.19; P = 0.002), and 16.4% (31/189) with obstructive coronary disease and hypotension (hazard ratio, 7.34; 95% CI, 3.37 to 15.96; P < 0.001). Hypotension was independently associated with cardiovascular events (hazard ratio, 3.17; 95% CI, 1.99 to 5.06; P < 0.001). This association remained in patients without obstructive disease and did not differ significantly across degrees of coronary disease (P value for interaction, 0.599).
In patients having noncardiac surgery, perioperative hypotension was associated with cardiovascular events regardless of the degree of coronary artery disease on preoperative coronary computed tomographic angiography.
围手术期低血压与非心脏手术患者的心血管事件有关。目前尚不清楚预先存在的冠状动脉疾病的严重程度是否决定了对围手术期低血压的心血管风险的易感性。
在这项对国际前瞻性盲法队列研究的亚研究的回顾性探索性分析中，955 名年龄在 45 岁或以上、有冠状动脉疾病病史或危险因素的患者在择期住院非心脏手术前接受了冠状动脉计算机断层扫描血管造影术。作者评估了血管造影结果与围手术期低血压（定义为手术期间收缩压低于 90mmHg 持续 10 分钟或以上，或手术后任何持续时间，且开始干预）之间的潜在相互作用对术后 30 天内心肌梗死或心血管死亡的复合结局的影响。血管造影评估者对研究结果不知情；患者、治疗临床医生和结局评估者对血管造影结果不知情。
心血管事件（术后 30 天内心肌梗死或心血管死亡）在 7.7%的患者（955 例中有 74 例）中发生，其中 2.7%（293 例中 8 例）无阻塞性冠状动脉疾病或低血压，而 6.7%（314 例中有 21 例）有阻塞性冠状动脉疾病但无低血压（危险比，2.51；95%置信区间，1.11 至 5.66；P = 0.027），14/159 例（8.8%）有低血压但无阻塞性冠状动脉疾病的患者（危险比，3.85；95%置信区间，1.62 至 9.19；P = 0.002），189 例（16.4%）有阻塞性冠状动脉疾病和低血压的患者（危险比，7.34；95%置信区间，3.37 至 15.96；P < 0.001）。低血压与心血管事件独立相关（危险比，3.17；95%置信区间，1.99 至 5.06；P < 0.001）。这种相关性在没有阻塞性疾病的患者中仍然存在，并且在冠状动脉疾病的严重程度上没有显著差异（交互检验 P 值，0.599）。
在接受非心脏手术的患者中，无论术前冠状动脉计算机断层扫描血管造影显示的冠状动脉疾病程度如何，围手术期低血压均与心血管事件相关。
