Academic Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
Department of Anaesthesia, Sheffield Teaching Hospitals, Sheffield, UK.
BJS Open. 2023 Mar 7;7(2). doi: 10.1093/bjsopen/zrad021.
Myocardial injury after non-cardiac surgery is diagnosed following asymptomatic troponin elevation in the perioperative interval. Myocardial injury after non-cardiac surgery is associated with high mortality rates and significant rates of major adverse cardiac events within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aimed to establish the rates of long-term morbidity and mortality associated with myocardial injury after non-cardiac surgery.
MEDLINE, Embase and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials, reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with myocardial injury after non-cardiac surgery, were included. Risk of bias was assessed using the Quality in Prognostic Studies tool. A random-effects model was used for the meta-analysis of outcome subgroups.
Searches identified 40 studies. The meta-analysis of 37 cohort studies found a rate of major adverse cardiac events-associated myocardial injury after non-cardiac surgery of 21 per cent and mortality following myocardial injury after non-cardiac surgery was 25 per cent at 1-year follow-up. A non-linear increase in mortality rate was observed up to 1 year after surgery. Major adverse cardiac event rates were also lower in elective surgery compared with a subgroup including emergency cases. The analysis demonstrated a wide variety of accepted myocardial injury after non-cardiac surgery and major adverse cardiac events diagnostic criteria within the included studies.
A diagnosis of myocardial injury after non-cardiac surgery is associated with high rates of poor cardiovascular outcomes up to 1 year after surgery. Work is needed to standardize diagnostic criteria and reporting of myocardial injury after non-cardiac surgery-related outcomes.
This review was prospectively registered with PROSPERO in October 2021 (CRD42021283995).
非心脏手术后心肌损伤是在围手术期无症状肌钙蛋白升高后诊断的。非心脏手术后心肌损伤与高死亡率以及手术后 30 天内重大不良心脏事件的发生率显著相关。然而，对于其在这段时间之后对死亡率和发病率的影响，人们了解较少。本系统评价和荟萃分析旨在确定非心脏手术后心肌损伤相关的长期发病率和死亡率。
检索 MEDLINE、Embase 和 Cochrane CENTRAL，并由两名审查员筛选摘要。纳入了报告非心脏手术后心肌损伤患者 30 天后死亡率和心血管结局的观察性研究和试验对照臂。使用预后研究质量工具评估偏倚风险。使用随机效应模型对亚组结果进行荟萃分析。
搜索共确定了 40 项研究。对 37 项队列研究的荟萃分析发现，非心脏手术后重大不良心脏事件相关心肌损伤的发生率为 21%，非心脏手术后心肌损伤的死亡率为 25%，随访 1 年。在手术后 1 年内观察到死亡率呈非线性增加。择期手术的重大不良心脏事件发生率也低于包括急诊病例的亚组。分析表明，在所纳入的研究中，非心脏手术后心肌损伤和重大不良心脏事件的诊断标准存在广泛的差异。
非心脏手术后心肌损伤的诊断与手术后 1 年内不良心血管结局的发生率较高相关。需要努力标准化非心脏手术后心肌损伤相关结局的诊断标准和报告。
本综述于 2021 年 10 月前瞻性地在 PROSPERO 中进行了登记（CRD42021283995）。
