The Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA.
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Can J Cardiol. 2021 Feb;37(2):224-231. doi: 10.1016/j.cjca.2020.04.034. Epub 2020 May 5.
Perioperative cardiovascular events are a leading cause of morbidity and mortality after noncardiac surgery. We propose a simplified method for perioperative risk stratification.
In a retrospective cohort study we identified patients who underwent noncardiac surgery between 2009 and 2015 in the US National Surgical Quality Improvement Program. Multivariable logistic regression models adjusted for age, sex, race, and surgery type were generated to estimate the effect of traditional cardiovascular risk factors (hypertension, diabetes mellitus, current smoking) on odds of perioperative myocardial infarction (MI). Time to event analysis was conducted using competing risk analysis, with MI as the outcome event and death as the competing risk.
A total of 3,848,501 noncardiac surgeries were identified. Postoperative MI occurred in 0.37% of patients and 1.04% of patients died. The 30-day event rate of perioperative MI increased in a stepwise fashion with additional risk factors (0.42% for 1, 0.82% for 2, and 1.08% for 3; P for trend < 0.001) after accounting for the competing risk of death. Compared with those with no risk factors, patients with 1, 2, and 3 risk factors had increased odds of MI (adjusted odds ratio [aOR], 2.07 [95% confidence interval (CI), 1.96-2.19]; aOR, 3.63 [95% CI, 3.43-3.85]; and aOR, 5.54 [95% CI, 5.09-6.04], respectively). Perioperative MI was rare (0.10%) in patients without risk factors.
Patients with cardiovascular risk factors are at increased risk of perioperative MI, those without risk factors are at low risk. Further evaluation is needed to determine the effect of a simplified risk score in the perioperative setting.
围手术期心血管事件是非心脏手术后发病率和死亡率的主要原因。我们提出了一种简化的围手术期风险分层方法。
在一项回顾性队列研究中，我们在美国国家手术质量改进计划中确定了 2009 年至 2015 年间接受非心脏手术的患者。使用多变量逻辑回归模型调整年龄、性别、种族和手术类型，估计传统心血管危险因素（高血压、糖尿病、当前吸烟）对围手术期心肌梗死（MI）发生几率的影响。使用竞争风险分析进行时间事件分析，MI 为结局事件，死亡为竞争风险。
共确定了 3848501 例非心脏手术。术后 MI 发生率为 0.37%，死亡率为 1.04%。在考虑死亡的竞争风险后，随着危险因素的增加（1 个危险因素的 30 天围手术期 MI 发生率为 0.42%，2 个危险因素的发生率为 0.82%，3 个危险因素的发生率为 1.08%；趋势 P < 0.001），围手术期 MI 的 30 天事件发生率呈逐步上升趋势。与无危险因素的患者相比，有 1、2 和 3 个危险因素的患者 MI 的发生几率增加（调整后的比值比[OR]，2.07[95%置信区间[CI]，1.96-2.19]；OR，3.63[95% CI，3.43-3.85]；OR，5.54[95% CI，5.09-6.04]）。无危险因素的患者围手术期 MI 罕见（0.10%）。
有心血管危险因素的患者围手术期 MI 风险增加，无危险因素的患者风险较低。需要进一步评估简化风险评分在围手术期的效果。
