Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
Center for Oral Health Services and Research (TkMidt), Trondheim, Norway.
Heart. 2023 May 15;109(11):839-845. doi: 10.1136/heartjnl-2022-321780.
To assess the short-term risk of acute myocardial infarction (AMI) associated with procedures performed at outpatient specialised hospital clinics.
In this case-crossover, population-based study, we identified first-time AMI cases aged ≥40 years via patient registries and linked them to their surgical intervention in Norway (2008-2016) and Sweden (2001-2014), respectively. The number of individuals with AMI who underwent procedures 0-7 days (hazard period) prior to the AMI diagnosis was compared with cases who were exposed 29-36 days (control period) before the AMI. A total of 6176 patients with AMI who underwent a procedure either during the defined hazard or control period contributed to the analyses. ORs with 95% CIs were computed using conditional logistic regression.
The mean age of the total population was 74.7 years and 64.6% were male. The relative risk was higher following procedures performed under general/regional anaesthesia for gastrointestinal endoscopy (OR, 4.23, 95% CI 1.58 to 11.31), vascular (OR, 3.12, 95% CI 1.10 to 8.90), urological/gynaecological (OR, 2.30, 95% CI 1.50 to 3.53) and orthopaedic (OR,1.78, 95% CI 1.30 to 2.44) procedures, and for ENT (ear, nose and throat) and mouth procedures (OR 1.53, 95% CI 1.19 to 1.99) performed under local anaesthesia.
This large population-based register study from two countries suggests that outpatient procedures are generally safe with regard to the postoperative risk of AMI. However, some procedures, such as gastrointestinal endoscopy, vascular procedures and urological/gynaecological procedures may increase the risk of AMI by twofold or threefold within the first 8 days after the procedures. Further studies are warranted to assess whether the effect is modified by cardiovascular medication or other clinical factors.
评估在门诊专科诊所进行的操作与急性心肌梗死（AMI）短期风险之间的关联。
在这项病例交叉、基于人群的研究中，我们通过患者登记册确定了年龄≥40 岁的首次 AMI 病例，并分别将他们与挪威（2008-2016 年）和瑞典（2001-2014 年）的外科手术干预联系起来。在 AMI 诊断前 0-7 天（危险期）接受手术的 AMI 患者人数与 AMI 发生前 29-36 天（对照期）接受手术的 AMI 患者人数进行了比较。共有 6176 名 AMI 患者在规定的危险或对照期内接受了手术，他们的资料被用于分析。使用条件逻辑回归计算比值比（OR）及其 95%置信区间（CI）。
总人群的平均年龄为 74.7 岁，64.6%为男性。接受全身/区域麻醉下进行的胃肠内镜（OR，4.23，95%CI 1.58 至 11.31）、血管（OR，3.12，95%CI 1.10 至 8.90）、泌尿科/妇科（OR，2.30，95%CI 1.50 至 3.53）和骨科（OR，1.78，95%CI 1.30 至 2.44）手术以及耳鼻喉科（OR，1.53，95%CI 1.19 至 1.99）和口腔手术（OR，1.53，95%CI 1.19 至 1.99）的患者术后发生 AMI 的相对风险较高。
这项来自两个国家的大型基于人群的登记研究表明，门诊手术一般是安全的，不会增加 AMI 的术后风险。然而，某些手术，如胃肠内镜、血管手术和泌尿科/妇科手术，可能会使术后 8 天内 AMI 的风险增加两倍或三倍。需要进一步的研究来评估该效果是否会受到心血管药物或其他临床因素的影响。
