CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France.
CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France; Université Lille, INSERM, CHU Lille, CIC-IT 1403, Lille, France; Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, Lille, France.
Eur J Vasc Endovasc Surg. 2021 Oct;62(4):550-558. doi: 10.1016/j.ejvs.2021.02.043. Epub 2021 Apr 10.
Myocardial injury after non-cardiac surgery (MINS) is an independent predictor of post-operative mortality in non-cardiac surgery patients and may increase health costs. Few data are available for MINS in vascular surgery patients, in general, and those undergoing fenestrated/branched endovascular aortic repairs (F/BEVAR), in particular. The incidence of MINS after F/BEVAR, the associated risk factors, and prognosis have not been determined. The aim of the present study was to help fill these knowledge gaps.
A single centre, retrospective study was carried out at a high volume F/BEVAR centre in a university hospital. Adult patients who underwent F/BEVAR between October 2010 and December 2018 were included. A high sensitivity troponin T (HsTnT) assay was performed daily in the first few post-operative days. MINS was defined as a HsTnT level ≥ 14 ng/L (MINS) or ≥ 20 ng/L (MINS). After assessment of the incidence of MINS, survival up to two years was estimated in a Kaplan-Meier analysis and the groups were compared according to MINS status. A secondary aim was to identify predictors of MINS.
Of the 387 included patients, 240 (62.0%) had MINS and 166 (42.9%) had MINS. In multivariable Cox models, both conditions were significantly associated with poor two year survival (MINS14: adjusted hazard ratio [aHR] 2.15, 95% confidence interval [CI] 1.10 - 4.19; MINS: aHR 2.43, 95% CI 1.36 - 4.34). In a multivariable logistic regression, age, revised cardiac risk index, duration of surgery, pre-operative estimated glomerular filtration rate (eGFR), and haemoglobin level were independent predictors of MINS.
After F/BEVAR surgery, the incidence of MINS was particularly high, regardless of the definition considered (MINS or MINS). MINS was significantly associated with poor two year survival. The modifiable predictors identified were duration of surgery, eGFR, and haemoglobin level.
非心脏手术后心肌损伤（MINS）是心脏手术后患者术后死亡率的独立预测因子，并且可能增加医疗保健费用。关于血管外科患者的 MINS 的数据很少，特别是关于接受开窗/分支血管腔内主动脉修复术（F/BEVAR）的患者。目前尚未确定 F/BEVAR 术后 MINS 的发生率、相关危险因素和预后。本研究旨在填补这些知识空白。
本研究在一家大学医院的大容量 F/BEVAR 中心进行了单中心回顾性研究。纳入 2010 年 10 月至 2018 年 12 月期间接受 F/BEVAR 的成年患者。术后前几天每天进行高敏肌钙蛋白 T（HsTnT）检测。MINS 的定义为 HsTnT 水平≥14ng/L（MINS）或≥20ng/L（MINS）。在评估 MINS 的发生率后，通过 Kaplan-Meier 分析估计了两年的生存情况，并根据 MINS 状态比较了各组。次要目的是确定 MINS 的预测因子。
在 387 名纳入的患者中，240 名（62.0%）有 MINS，166 名（42.9%）有 MINS。在多变量 Cox 模型中，这两种情况均与两年不良生存率显著相关（MINS14：调整后的危险比[aHR]2.15，95%置信区间[CI]1.10-4.19；MINS：aHR 2.43，95%CI 1.36-4.34）。在多变量逻辑回归中，年龄、修订后的心脏风险指数、手术持续时间、术前估算肾小球滤过率（eGFR）和血红蛋白水平是 MINS 的独立预测因子。
在 F/BEVAR 手术后，MINS 的发生率特别高，无论考虑哪种定义（MINS 或 MINS）。MINS 与两年不良生存率显著相关。确定的可改变的预测因子是手术持续时间、eGFR 和血红蛋白水平。
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