Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Circ J. 2021 Oct 25;85(11):2081-2088. doi: 10.1253/circj.CJ-21-0106. Epub 2021 May 12.
This study compared myocardial injury after non-cardiac surgery (MINS) and mortalities between patients under and over the age of 45 years.
From January 2010 and June 2019, patients with cardiac troponin measurement within 30 days after non-cardiac surgery were enrolled and divided into groups according to age: >45 (≥45 years) and <45 (<45 years). Further analyses were conducted only in patients who were diagnosed with MINS. The outcomes were MINS and 30-day mortality. Of the 35,223 patients, 31,161 (88.5%) patients were in the >45-year group and 4,062 (11.5%) were in the <45-year group. After adjustment with inverse probability of weighting, the <45-years group showed a lower incidence of MINS and cardiovascular mortality (16.6% vs. 11.7%; odds ratio, 0.77; 95% confidence interval [CI], 0.69-0.84; P<0.001 and 0.4% vs. 0.2%; hazard ratio [HR], 0.41; 95% CI, 0.19-0.88; P=0.02, respectively). In a comparison of only the <45-years group, MINS was associated with increased 30-day mortality (0.7% vs. 10.3%; HR, 10.48; 95% CI, 6.18-17.78; P<0.001), but the mortalities of patients with MINS did not differ according to age.
MINS has a comparable prognostic impact in patients aged under and over 45 years; therefore, future studies need to also consider patients aged <45 years regarding risk factors of MINS and screening of perioperative troponin elevation.
本研究比较了非心脏手术后心肌损伤（MINS）和 45 岁以上与 45 岁以下患者的死亡率。
2010 年 1 月至 2019 年 6 月，连续纳入了非心脏手术后 30 天内心肌肌钙蛋白检测的患者，并根据年龄分为：>45（≥45 岁）和<45（<45 岁）。仅对诊断为 MINS 的患者进行了进一步分析。结果为 MINS 和 30 天死亡率。在 35223 例患者中，31161 例（88.5%）患者在>45 岁组，4062 例（11.5%）患者在<45 岁组。经逆概率加权调整后，<45 岁组 MINS 和心血管死亡率较低（16.6%比 11.7%；比值比，0.77；95%置信区间[CI]，0.69-0.84；P<0.001 和 0.4%比 0.2%；危险比[HR]，0.41；95%CI，0.19-0.88；P=0.02）。仅在<45 岁组比较中，MINS 与 30 天死亡率增加相关（0.7%比 10.3%；HR，10.48；95%CI，6.18-17.78；P<0.001），但 MINS 患者的死亡率与年龄无关。
MINS 在 45 岁以上和以下的患者中的预后影响相当；因此，未来的研究还需要考虑年龄<45 岁的患者的 MINS 危险因素和围手术期肌钙蛋白升高的筛查。
