Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York.
Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York; Department of Surgery, New York University Grossman School of Medicine, New York, New York.
Am J Cardiol. 2022 May 1;170:40-46. doi: 10.1016/j.amjcard.2022.01.017. Epub 2022 Feb 19.
Patients with ischemic heart disease frequently undergo noncardiac surgery. We examined perioperative surgical outcomes in patients with and without previous coronary revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Adults ≥45 years old who underwent noncardiac surgery between 2010 and 2014 were identified from the National Inpatient Sample. Previous CABG and PCI were identified using International Classification of Diseases, Ninth Revision codes. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the composite of in-hospital mortality, acute myocardial infarction, and acute ischemic stroke. Multivariable logistic regression models were used to estimate associations between previous coronary revascularization and surgical outcomes after adjustment for clinical covariates. We identified 25,091,140 hospitalizations for noncardiac surgery, of which 8.4% had a history of coronary revascularization (47% previous CABG without PCI, 45% previous PCI without CABG, and 8% previous CABG and PCI). Hospitalized patients with versus without previous coronary revascularization had a higher crude incidence (4.0% vs 2.6%, p <0.001) but lower odds of MACCE (adjusted odds ratio 0.96, 95% CI 0.94 to 0.98) driven by a lower risk of death and ischemic stroke. When analyzed by revascularization strategy, lower odds of MACCE were restricted to patients with previous CABG, driven by excess perioperative acute myocardial infarction risks after PCI. In patients with established cardiovascular disease, previous coronary revascularization was associated with lower odds of MACCE (adjusted odds ratio 0.76, 95% CI 0.75 to 0.78), regardless of revascularization strategy. In conclusion, previous coronary revascularization is associated with lower odds of MACCE after noncardiac surgery, but perioperative risks vary by mode of coronary revascularization.
患有缺血性心脏病的患者经常接受非心脏手术。我们检查了先前通过冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）进行冠状动脉血运重建的患者和未进行冠状动脉血运重建的患者的围手术期手术结果。从 2010 年至 2014 年期间，从国家住院患者样本中确定了年龄≥45 岁的接受非心脏手术的成年人。先前的 CABG 和 PCI 使用国际疾病分类，第九修订版代码确定。主要不良心血管和脑血管事件（MACCE）被定义为住院死亡率，急性心肌梗死和急性缺血性卒中的组合。使用多变量逻辑回归模型估计了在调整临床协变量后，先前的冠状动脉血运重建与手术后手术结果之间的关联。我们确定了 25091140 例非心脏手术住院患者，其中 8.4%有冠状动脉血运重建史（47%先前 CABG 无 PCI，45%先前 PCI 无 CABG，8%先前 CABG 和 PCI）。与未进行先前冠状动脉血运重建的住院患者相比，前者有更高的粗发生率（4.0%对 2.6%，p<0.001），但 MACCE 的几率较低（调整后的比值比为 0.96，95%CI 为 0.94 至 0.98），这归因于死亡率和缺血性卒中的风险较低。按血运重建策略分析时，仅在先前进行 CABG 的患者中，MACCE 的几率降低归因于 PCI 后围手术期急性心肌梗死风险增加。在患有已确立的心血管疾病的患者中，先前的冠状动脉血运重建与 MACCE 的几率较低（调整后的比值比为 0.76，95%CI 为 0.75 至 0.78）有关，而与血运重建策略无关。总之，先前的冠状动脉血运重建与非心脏手术后 MACCE 的几率较低有关，但围手术期风险因冠状动脉血运重建的方式而异。
