Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Center for Oral Health Services and Research (TkMidt), Trondheim, and Clinic of Surgery, St. Olav's University Hospital, Trondheim, Norway (A.S.).
Department of Global Public Health, Institute of Environmental Medicine, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (K.G.).
Ann Intern Med. 2022 May;175(5):628-633. doi: 10.7326/M20-6618. Epub 2022 Mar 22.
Preoperative cardiovascular evaluations are frequently done before ambulatory ophthalmologic procedures. However, whether these procedures can trigger an acute myocardial infarction (AMI) is unknown.
To assess the short-term risk for AMI associated with ophthalmologic procedures.
Case-crossover design.
Population-based nationwide study from Norway and Sweden.
First-time patients with AMI, aged 40 years and older, identified via inpatient registries and linked to outpatient surgical procedures in Norway (2008 to 2014) and Sweden (2001 to 2014), respectively.
Using self-matching, for each participant, exposure to ophthalmologic procedures in the 0 to 7 days before AMI diagnosis (hazard period) was compared with an 8-day period 30 days earlier, that is, days 29 to 36 before AMI (control period) to estimate the relative risk for an AMI the week after an ophthalmologic procedure. The odds ratios (ORs) with 95% CIs were calculated, using conditional logistic regression. Only patients who had a procedure of interest during either the hazard or control period were included.
For the 806 patients with AMI included in this study, there was a lower likelihood of AMI in the week after an ophthalmologic procedure than during the control week (OR 0.83; 95% CI, 0.75 to 0.91). Furthermore, there was no evidence of increased risk for AMI when analyses were stratified by surgery subtype, anesthesia (local or general), duration, invasiveness (low, intermediate, or high), patient's age (<65 years or ≥65 years), or comorbidity (none vs. any).
Potential bias from time-varying confounders between the hazard and the control periods.
Ophthalmologic procedures done in an outpatient setting did not seem to be associated with an increased risk for AMI.
Central Norway Regional Health Authority and the Swedish Research Council.
在门诊眼科手术前，通常会进行心血管评估。然而，这些手术是否会引发急性心肌梗死（AMI）尚不清楚。
评估眼科手术与 AMI 相关的短期风险。
病例交叉设计。
来自挪威和瑞典的全国性基于人群的研究。
首次发生 AMI 的患者，年龄在 40 岁及以上，通过住院患者登记处确定，并与挪威（2008 年至 2014 年）和瑞典（2001 年至 2014 年）的门诊手术相关联。
使用自我匹配，对于每位参与者，在 AMI 诊断前 0 至 7 天（危险期）暴露于眼科手术与 AMI 前 30 天（控制期，即 AMI 前第 29 至 36 天）进行比较，以估计在眼科手术后一周内发生 AMI 的相对风险。使用条件逻辑回归计算比值比（OR）及其 95%置信区间（CI）。仅纳入在危险期或控制期内有感兴趣手术的患者。
在本研究纳入的 806 名 AMI 患者中，在眼科手术后一周内发生 AMI 的可能性低于控制周（OR 0.83；95%CI，0.75 至 0.91）。此外，当按手术亚型、麻醉（局部或全身）、持续时间、侵入性（低、中、高）、患者年龄（<65 岁或≥65 岁）或合并症（无或有）进行分层分析时，没有证据表明 AMI 风险增加。
在危险期和控制期之间存在时变混杂因素的潜在偏差。
门诊进行的眼科手术似乎与 AMI 风险增加无关。
挪威中部地区卫生局和瑞典研究理事会。
