Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey.
Department of Neurosurgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Neurosurg Rev. 2022 Jun;45(3):2151-2159. doi: 10.1007/s10143-021-01722-y. Epub 2022 Jan 11.
Perioperative myocardial injury is an important reason of mortality and morbidity after neurosurgery. It usually is missed due to its asymptomatic character. In the present study, we investigated myocardial injury after noncardiac surgery (MINS) incidence, the risk factor for MINS, and association of MINS with 30-day mortality in neurosurgery patients. Patients with cardiac risk who underwent elective neurosurgery were enrolled to present prospective cohort study. The patients' demographics, comorbidities, medications used, medical history, and type of operation were recorded. The high-sensitivity cardiac troponin (hs-cTn) levels of the patients were measured 12, 24, and 48 h after surgery. The patients were considered MINS-positive if at least one of their postoperative hs-cTn measurement values was ≥ 14 ng/l. All the patients were followed up for 30 days after surgery for evaluation of their outcomes, including total mortality, mortality due to cardiovascular cause, and major cardiac events. A total of 312 patients completed the study and 64 (20.5%) of them was MINS-positive. Long antiplatelet or anticoagulant drug cessation time (OR: 4.9, 95% CI: 2.1-9.4) was found the most prominent risk factor for MINS occurrence. The total mortality rate was 2.4% and 6.2% in patients MINS-negative and MINS-positive, respectively (p = 0.112). The mortality rate due to cardiovascular reasons (0.8% for without MINS, 4.7 for with MINS, and p = 0.026) and incidence of the major cardiac events (4% for without MINS, 10.9 for with MINS, and p = 0.026) were significantly higher in patients with MINS. MINS is a common problem after neurosurgery, and high postoperative hs-cTn level is associated with mortality and morbidity.
围手术期心肌损伤是神经外科术后死亡率和发病率升高的一个重要原因。由于其无症状的特点，通常会被忽视。在本研究中，我们调查了非心脏手术后心肌损伤（MINS）的发生率、MINS 的危险因素，以及 MINS 与神经外科患者 30 天死亡率的关系。我们纳入了接受择期神经外科手术的有心脏风险的患者，进行前瞻性队列研究。记录患者的人口统计学资料、合并症、使用的药物、病史和手术类型。术后 12、24 和 48 小时测量患者的高敏肌钙蛋白（hs-cTn）水平。如果至少有一次术后 hs-cTn 测量值≥14ng/L，则认为患者 MINS 阳性。所有患者术后均随访 30 天，评估其结局，包括总死亡率、心血管原因死亡率和主要心脏不良事件。共有 312 例患者完成了研究，其中 64 例（20.5%）患者 MINS 阳性。抗血小板或抗凝药物停药时间较长（OR：4.9，95%CI：2.1-9.4）是 MINS 发生的最显著危险因素。MINS 阴性和 MINS 阳性患者的总死亡率分别为 2.4%和 6.2%（p=0.112）。无 MINS 的心血管原因死亡率为 0.8%，有 MINS 的心血管原因死亡率为 4.7%（p=0.026），无 MINS 的主要心脏不良事件发生率为 4%，有 MINS 的主要心脏不良事件发生率为 10.9%（p=0.026），MINS 患者死亡率和发病率明显更高。MINS 是神经外科手术后的常见问题，术后 hs-cTn 水平升高与死亡率和发病率有关。
