Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
Heart Vessels. 2021 Sep;36(9):1317-1326. doi: 10.1007/s00380-021-01818-x. Epub 2021 Mar 9.
The prediction of a perioperative adverse cardiovascular event (PACE) is an important clinical issue in the medical management of patients undergoing noncardiac surgery. Although several predictors have been reported, simpler and more practical predictors of PACE have been needed. The aim of this study was to investigate the predictors of PACE in noncardiac surgery. We retrospectively analyzed 723 patients who were scheduled for elective noncardiac surgery and underwent preoperative examinations including 12-lead electrocardiography, transthoracic echocardiography, and blood test. PACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, congestive heart failure, arrhythmia attack that needs emergency treatment (rapid atrial fibrillation, ventricular tachycardia, and bradycardia), acute pulmonary embolism, asystole, pulseless electrical activity, or stroke during 30 days after surgery. PACE occurred in 54 (7.5%) of 723 patients. High-risk operation (11% vs. 3%, p = 0.003) was more often seen, left ventricular ejection fraction (LVEF) (55 ± 8% vs. 60 ± 7%, p = 0.001) and preoperative hemoglobin level (11.8 ± 2.2 g/dl vs. 12.7 ± 2.0 g/dl, p = 0.001) were lower in patients with PACE compared to those without PACE. By multivariate logistic regression analysis, high-risk operation (odds ratio (OR): 7.05, 95% confidence interval (CI) 2.16-23.00, p = 0.001), LVEF (OR 1.06, every 1% decrement, 95% CI 1.03-1.09, p = 0.001), and preoperative hemoglobin level (OR 1.22, every 1 g/dl decrement, 95% CI 1.07-1.39, p = 0.003) were identified as independent predictors of PACE. Receiver operating characteristic analysis demonstrated that LVEF of 58% (sensitivity = 80%, specificity = 61%, area under the curve (AUC) = 0.723) and preoperative hemoglobin level of 12.2 g/dl (sensitivity = 63%, specificity = 64%, AUC = 0.644) were optimal cut-off values for predicting PACE. High-risk operation, reduced LVEF, and reduced preoperative hemoglobin level were independently associated with PACE in patients undergoing noncardiac surgery.
围术期不良心血管事件（PACE）的预测是接受非心脏手术患者医疗管理中的一个重要临床问题。尽管已经报道了几种预测因素，但仍需要更简单、更实用的 PACE 预测因素。本研究旨在探讨非心脏手术患者 PACE 的预测因素。我们回顾性分析了 723 名计划接受择期非心脏手术并接受术前检查的患者，包括 12 导联心电图、经胸超声心动图和血液检查。PACE 定义为术后 30 天内发生心脏性死亡、非致死性心肌梗死、不稳定型心绞痛、充血性心力衰竭、需要紧急治疗的心律失常发作（快速心房颤动、室性心动过速和心动过缓）、急性肺栓塞、心脏停搏、无脉电活动或中风。723 例患者中 54 例（7.5%）发生 PACE。高危手术（11%比 3%，p=0.003）更为常见，左心室射血分数（LVEF）（55±8%比 60±7%，p=0.001）和术前血红蛋白水平（11.8±2.2 g/dl 比 12.7±2.0 g/dl，p=0.001）在发生 PACE 的患者中较低。通过多变量逻辑回归分析，高危手术（比值比（OR）：7.05，95%置信区间（CI）2.16-23.00，p=0.001）、LVEF（OR 1.06，每 1%下降，95%CI 1.03-1.09，p=0.001）和术前血红蛋白水平（OR 1.22，每 1 g/dl 下降，95%CI 1.07-1.39，p=0.003）被确定为 PACE 的独立预测因素。受试者工作特征分析显示，LVEF 为 58%（敏感性=80%，特异性=61%，曲线下面积（AUC）=0.723）和术前血红蛋白水平为 12.2 g/dl（敏感性=63%，特异性=64%，AUC=0.644）是预测 PACE 的最佳截断值。高危手术、LVEF 降低和术前血红蛋白水平降低与非心脏手术患者的 PACE 独立相关。
