Liu Le Yi, Liu Zi Jia, Xu Guang Yan, Zhang Feng Yan, Xu Li, Huang Yu Guang
Department of Anesthesiology,Wuhu Traditional Chinese Hospital,Wuhu,Anhui 241000,China.
Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020 Dec 30;42(6):732-739. doi: 10.3881/j.issn.1000-503X.12635.
Objective To explore the predictive ability of the revised cardiac risk index(RCRI)in elderly patients with coronary heart disease(CHD)undergoing non-cardiac surgery. Methods We performed a retrospective study including a total of 2100 patients,aged≥65 with a history of CHD who underwent non-cardiac surgery form January 2013 to September 2019.The preoperative,intraoperative and postoperative clinical data were extracted from an electronic database.The RCRI and reconstructed-RCRI(R-RCRI)score of each patient were calculated.The primary end point was defined as an occurrence of perioperative MACE.Multivariate logistic regression analysis was performed to evaluate the risk factors of perioperative MACE.The area under the receiver operating characteristic(ROC)curve was used to compare the predictive value of RCRI,R-RCRI,and the new risk scoring system of the study for perioperative MACE. Results The incidence of perioperative MACE in elderly patients with CHD was 5.4%.Six independent risk factors of perioperative MACE for this population were identified:age≥80 years;female;history of heart failure;insulin-depended diabetes mellitus;preoperative ST segment abnormality;American Society of Anesthesiologists grade≥Ⅲ,and the risk index was 2,2,2,2,2 and 3 respectively.The area under ROC curve of RCRI,R-RCRI and risk scoring system in this study were 0.586,0.552 and 0.741. Conclusion The correlation between RCRI score and perioperative MACE was poor in elderly patients with CHD undergoing non-cardiac surgery,and a better cardiac risk assessment method should be established for this population.
目的 探讨改良心脏风险指数（RCRI）对老年冠心病（CHD）患者非心脏手术的预测能力。方法 我们进行了一项回顾性研究，纳入2013年1月至2019年9月期间共2100例年龄≥65岁且有CHD病史并接受非心脏手术的患者。从电子数据库中提取术前、术中和术后的临床数据。计算每位患者的RCRI和重构RCRI（R-RCRI）评分。主要终点定义为围手术期发生主要不良心血管事件（MACE）。进行多因素逻辑回归分析以评估围手术期MACE的危险因素。采用受试者工作特征（ROC）曲线下面积比较RCRI、R-RCRI以及本研究新的风险评分系统对围手术期MACE的预测价值。结果 老年CHD患者围手术期MACE的发生率为5.4%。确定了该人群围手术期MACE的六个独立危险因素：年龄≥80岁；女性；心力衰竭病史；胰岛素依赖型糖尿病；术前ST段异常；美国麻醉医师协会分级≥Ⅲ级，风险指数分别为2、2、2、2、2和3。本研究中RCRI、R-RCRI和风险评分系统的ROC曲线下面积分别为0.586、0.552和0.741。结论 在接受非心脏手术的老年CHD患者中，RCRI评分与围手术期MACE的相关性较差，应为该人群建立更好的心脏风险评估方法。
