Yoon Hyun-Kyu, Jun Kwanghoon, Park Sun-Kyung, Ji Sang-Hwan, Jang Young-Eun, Yoo Seokha, Kim Jin-Tae, Kim Won Ho
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
J Clin Med. 2020 Feb 5;9(2):429. doi: 10.3390/jcm9020429.
Patients undergoing noncardiac surgery after coronary stent implantation are at an increased risk of thrombotic complications. Volatile anesthetics are reported to have organ-protective effects against ischemic injury. Propofol has an anti-inflammatory action that can mitigate ischemia-reperfusion injury. However, the association between anesthetic agents and the risk of major adverse cardiovascular and cerebral event (MACCE) has never been studied before. In the present study, a total of 1630 cases were reviewed. Four different propensity score matchings were performed to minimize selection bias (propofol-based total intravenous anesthesia (TIVA) vs. volatile anesthetics; TIVA vs. sevoflurane; TIVA vs. desflurane; and sevoflurane vs. desflurane). The incidence of MACCE in these four propensity score-matched cohorts was compared. As a sensitivity analysis, a multivariable logistic regression analysis was performed to identify independent predictors for MACCE during the postoperative 30 days both in total and matched cohorts (TIVA vs. volatile agent). MACCE occurred in 6.0% of the patients. Before matching, there was a significant difference in the incidence of MACCE between TIVA and sevoflurane groups (TIVA 5.1% vs. sevoflurane 8.2%, = 0.006). After matching, there was no significant difference in the incidence of MACCE between the groups of any pairs (TIVA 6.5% vs. sevoflurane 7.7%; = 0.507). The multivariable logistic regression analysis revealed no significant association of the volatile agent with MACCE (odds ratio 1.48, 95% confidence interval 0.92-2.37, = 0.104). In conclusion, the choice of anesthetic agent for noncardiac surgery did not significantly affect the development of MACCE in patients with previous coronary stent implantation. However, further randomized trials are needed to confirm our results.
接受冠状动脉支架植入术后进行非心脏手术的患者发生血栓并发症的风险增加。据报道，挥发性麻醉剂对缺血性损伤具有器官保护作用。丙泊酚具有抗炎作用，可减轻缺血再灌注损伤。然而，麻醉药物与主要不良心血管和脑血管事件（MACCE）风险之间的关联此前从未被研究过。在本研究中，共回顾了1630例病例。进行了四种不同的倾向评分匹配，以尽量减少选择偏倚（丙泊酚全凭静脉麻醉（TIVA）与挥发性麻醉剂；TIVA与七氟醚；TIVA与地氟醚；七氟醚与地氟醚）。比较了这四个倾向评分匹配队列中MACCE的发生率。作为敏感性分析，进行了多变量逻辑回归分析，以确定总体队列和匹配队列（TIVA与挥发性药物）术后30天内MACCE的独立预测因素。6.0%的患者发生了MACCE。匹配前，TIVA组和七氟醚组MACCE发生率存在显著差异（TIVA 5.1% vs.七氟醚8.2%，P = 0.006）。匹配后，任何配对组之间MACCE发生率均无显著差异（TIVA 6.5% vs.七氟醚7.7%；P = 0.507）。多变量逻辑回归分析显示，挥发性药物与MACCE无显著关联（优势比1.48，95%置信区间0.92 - 2.37，P = 0.104）。总之，对于既往有冠状动脉支架植入的患者，非心脏手术麻醉药物的选择对MACCE的发生没有显著影响。然而，需要进一步的随机试验来证实我们的结果。
