非心脏手术后 1 型与 2 型围手术期心肌梗死的特征和结局。
Characteristics and Outcomes of Type 1 versus Type 2 Perioperative Myocardial Infarction After Noncardiac Surgery.
机构信息
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY.
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY.
出版信息
Am J Med. 2022 Feb;135(2):202-210.e3. doi: 10.1016/j.amjmed.2021.08.028. Epub 2021 Sep 22.
BACKGROUND
Perioperative myocardial infarction is frequently attributed to type 2 myocardial infarction, a mismatch in myocardial oxygen supply-demand without unstable coronary artery disease. Our aim was to identify characteristics, management, and outcomes of perioperative type 1 versus type 2 myocardial infarction among surgical inpatients.
METHODS
Adults age ≥45 years hospitalized for noncardiac surgery were identified in the United States. Perioperative myocardial infarction were identified using International Classification of Diseases, 10th revision (ICD-10) codes. Clinical characteristics, invasive myocardial infarction management, mortality, and readmissions were assessed by myocardial infarction subtype.
RESULTS
Among 4,755,382 surgical hospitalizations, we identified 38,975 perioperative myocardial infarctions (0.82%), with type 2 infarction in 42%. Patients with type 2 myocardial infarction were older, more likely to be women, and less likely to have cardiovascular comorbidities compared with type 1 myocardial infarction. Fewer patients with type 2 myocardial infarction underwent invasive management than type 1 myocardial infarction (6.7% vs 28.8%, P < .001). Type 2 myocardial infarction mortality was lower than type 1 myocardial infarction mortality (12.1% vs 17.4%, P < .001; adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.45-0.59). Invasive management of perioperative myocardial infarction was associated with lower mortality in type 1 (aOR 0.56, 95% CI 0.49-0.74) but not type 2 (aOR 1.19, 95% CI 0.77-1.85) myocardial infarction. Among survivors, there was no difference in 90-day hospital readmission between type 2 and type 1 perioperative myocardial infarction (36.5% vs 36.1%, P = .72).
CONCLUSIONS
Type 2 myocardial infarctions account for approximately 40% of perioperative myocardial infarctions. Patients with type 2 perioperative myocardial infarction are less likely to undergo invasive management and have lower mortality compared with those with type 1 perioperative myocardial infarction.
背景
围手术期心肌梗死通常归因于 2 型心肌梗死，即心肌供氧与需氧之间不匹配而无不稳定型冠状动脉疾病。我们的目的是确定围手术期 1 型与 2 型心肌梗死患者的特征、治疗方法和结局，这些患者为接受非心脏手术住院的成年人。
方法
在美国，我们确定了年龄≥45 岁、因非心脏手术住院的成年人。使用国际疾病分类，第 10 版（ICD-10）编码识别围手术期心肌梗死。根据心肌梗死亚型评估临床特征、侵入性心肌梗死管理、死亡率和再入院率。
结果
在 4755382 例手术住院患者中，我们发现 38975 例围手术期心肌梗死（0.82%），其中 2 型心肌梗死占 42%。与 1 型心肌梗死相比，2 型心肌梗死患者年龄更大，更可能为女性，且心血管合并症更少。与 1 型心肌梗死相比，接受侵入性治疗的 2 型心肌梗死患者更少（6.7%比 28.8%，P<.001）。2 型心肌梗死死亡率低于 1 型心肌梗死死亡率（12.1%比 17.4%，P<.001；调整后比值比[OR]0.51，95%置信区间[CI]0.45-0.59）。围手术期心肌梗死的侵入性治疗与 1 型心肌梗死（OR 0.56，95%CI 0.49-0.74）但与 2 型心肌梗死（OR 1.19，95%CI 0.77-1.85）的死亡率降低相关。在幸存者中，2 型和 1 型围手术期心肌梗死的 90 天院内再入院率无差异（36.5%比 36.1%，P=0.72）。
结论
2 型心肌梗死占围手术期心肌梗死的 40%左右。与 1 型围手术期心肌梗死相比，2 型围手术期心肌梗死患者更不可能接受侵入性治疗，死亡率更低。
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