Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America.
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America.
J Clin Anesth. 2022 Nov;82:110932. doi: 10.1016/j.jclinane.2022.110932. Epub 2022 Jul 15.
Chest pain is relatively common postoperatively. Myocardial infarction (MI) is one cause of chest pain after surgery, but chest pain also results from less severe conditions. Because of its potential severity, chest pain usually prompts the activation of Rapid Response Systems (RRS). While chest pain is a cardinal symptom of myocardial ischemia in the non-surgical setting, the significance and relevance of chest pain after noncardiac surgery remains unclear.
We conducted a retrospective analysis of noncardiac surgical inpatients for whom postoperative chest pain triggered our multidisciplinary RRS.
Surgical wards at Cleveland Clinic, Cleveland, OH.
Postsurgical patients after noncardiac surgery in whom the RSS system was activated for chest pain.
RRS specified interventions like ECG readings, troponin measurements, transfer to ICU.
Our primary outcome was MI. Secondary outcomes included the proportion of patients who had an ECG performed, troponin measurements, echocardiography, cardiac catheterization, and were admitted to the Intensive Care Unit (ICU).
5850 surgical patients experienced postoperative chest pain and triggered an RRS activation between 2009 and 2019. A total of 3110 patients had troponin T measured within 6 h after RRS activation, and 538 of them (17%) had elevated troponin, meeting the Fourth Universal Definition criteria for MI. Additionally, 2 patients had ST-segment elevation infarction (STEMI) without troponin measurement. Among the 540 patients with MI, only 19 (3.5%) were diagnosed with a STEMI by ECG, 388 (72%) had echocardiography, 43 patients (8%) had cardiac catheterization, 8 patients (1.5%) required emergent cardiac surgery, and 424 (79%) were admitted to an ICU.
Chest pain is a serious clinical sign, often indicating a postoperative myocardial infarction, and therefore should be taken seriously. Troponin screening should be routinely considered in postsurgical patients who report chest pain.
手术后胸痛较为常见。心肌梗死（MI）是手术后胸痛的原因之一，但胸痛也可能由病情较轻的情况引起。由于其潜在的严重性，胸痛通常会促使快速反应系统（RRS）的激活。虽然胸痛是非手术环境中心肌缺血的主要症状，但非心脏手术后胸痛的意义和相关性尚不清楚。
我们对因术后胸痛而触发我们多学科 RRS 的非心脏手术住院患者进行了回顾性分析。
克利夫兰诊所的外科病房，克利夫兰，俄亥俄州。
非心脏手术后出现胸痛且 RRS 系统因胸痛而激活的术后患者。
RRS 指定了干预措施，如心电图读数、肌钙蛋白测量、转移到 ICU。
我们的主要结局是 MI。次要结局包括进行心电图检查、肌钙蛋白测量、超声心动图、心导管检查和入住重症监护病房（ICU）的患者比例。
2009 年至 2019 年期间，5850 名外科患者经历了术后胸痛并触发了 RRS 激活。共有 3110 名患者在 RRS 激活后 6 小时内测量了肌钙蛋白 T，其中 538 名（17%）肌钙蛋白升高，符合第四通用定义标准的 MI。此外，有 2 名患者出现 ST 段抬高型心肌梗死（STEMI）但未进行肌钙蛋白测量。在 540 名 MI 患者中，只有 19 名（3.5%）通过心电图诊断为 STEMI，388 名（72%）进行了超声心动图检查，43 名患者（8%）进行了心导管检查，8 名患者（1.5%）需要紧急心脏手术，424 名（79%）患者入住 ICU。
胸痛是一种严重的临床症状，常提示术后心肌梗死，因此应引起重视。对于报告胸痛的术后患者，应常规考虑进行肌钙蛋白筛查。
