Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China (mainland).
Department of Medical Record Management and Statistics, Beijing Jishuitan Hospital, Beijing, China (mainland).
Med Sci Monit. 2021 Dec 25;27:e932036. doi: 10.12659/MSM.932036.
BACKGROUND Myocardial injury after noncardiac surgery (MINS) is common and associated with postoperative mortality. We assessed MINS occurrence and association with 30-day and long-term mortality in older adult patients undergoing orthopedic surgery in China. MATERIAL AND METHODS This was a retrospective study of consecutive patients who underwent orthopedic surgery between January 1, 2009, and December 31, 2017, at Beijing Jishuitan Hospital. MINS was defined as postoperative troponin I peak elevation above the 99th percentile upper reference limit (>0.034 µg/L) within 30 days after surgery. Outcomes were 30-day postoperative mortality and long-term all-cause mortality. RESULTS From 34 901 patients, 5897 (16.9%) had serial troponin I measurements, and 266 (4.5%) had MINS after surgery. Mean patient age was 71.1±9.2 years; 32.9% were male. Among patients with MINS, 180 had myocardial infarction (MI) (3.2%). Patients with MI had higher 30-day and long-term mortality than those without MI (8.9% vs 1.2%; P<0.016 and 18.9% vs 3.5%; P=0.001). Male sex (OR 5.87, 95% CI 1.75-19.67; P=0.004), RCRI ≥2 (OR 5.05, 95% CI 1.67-15.31; P=0.004), and MI (OR 9.13, 95% CI 1.13-73.63; P=0.011) were independently associated with 30-day mortality. Age (HR 1.07, 95% CI 1.03-1.11; P=0.001), male sex (HR 2.96, 95% CI 1.51-5.80; P=0.002), RCRI ≥2 (HR 2.01, 95% CI 1.03-3.94; P=0.041), orthopedic trauma (HR 3.40, 95% CI 1.00-11.44; P=0.049), and MI (HR 7.33, 95% CI 2.22-24.20; P=0.001) were predictors of 2-year mortality. CONCLUSIONS Perioperative MI was independently associated with 30-day and long-term mortality after orthopedic surgery, providing a potential indicator of high risk of mortality in patients who could benefit from targeted prevention and intervention.
非心脏手术后心肌损伤（MINS）很常见，与术后死亡率有关。我们评估了老年骨科手术患者 MINS 的发生情况及其与 30 天和长期死亡率的关系。
这是一项回顾性研究，连续纳入 2009 年 1 月 1 日至 2017 年 12 月 31 日在北京积水潭医院接受骨科手术的患者。MINS 定义为术后 30 天内肌钙蛋白 I 峰值升高超过第 99 百分位上限 (>0.034μg/L)。研究终点为 30 天术后死亡率和长期全因死亡率。
在 34901 例患者中，5897 例（16.9%）进行了连续肌钙蛋白 I 测量，266 例（4.5%）术后发生 MINS。患者平均年龄为 71.1±9.2 岁，32.9%为男性。在发生 MINS 的患者中，180 例发生心肌梗死（MI）（3.2%）。与无 MI 的患者相比，MI 患者的 30 天和长期死亡率更高（8.9% vs 1.2%；P<0.016 和 18.9% vs 3.5%；P=0.001）。男性（OR 5.87，95%CI 1.75-19.67；P=0.004）、RCRI≥2（OR 5.05，95%CI 1.67-15.31；P=0.004）和 MI（OR 9.13，95%CI 1.13-73.63；P=0.011）与 30 天死亡率独立相关。年龄（HR 1.07，95%CI 1.03-1.11；P=0.001）、男性（HR 2.96，95%CI 1.51-5.80；P=0.002）、RCRI≥2（HR 2.01，95%CI 1.03-3.94；P=0.041）、骨科创伤（HR 3.40，95%CI 1.00-11.44；P=0.049）和 MI（HR 7.33，95%CI 2.22-24.20；P=0.001）是 2 年死亡率的预测因素。
围手术期 MI 与骨科手术后 30 天和长期死亡率独立相关，为术后死亡率高的患者提供了一个潜在的指标，这些患者可能受益于有针对性的预防和干预。
