Department of Anesthesiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China.
PLoS One. 2023 Jun 15;18(6):e0286431. doi: 10.1371/journal.pone.0286431. eCollection 2023.
Postoperative myocardial injury after noncardiac surgery is common and is associated with short- and long-term morbidity and mortality. However, the incidence and risk factors for postoperative acute myocardial injury (POAMI) are currently unknown due to inconsistent definitions.
We systematically searched PubMed and Web of Science to identify studies that applied the change value of preoperative and postoperative cardiac troponins to define cardiac injury. We estimated the pooled incidence, risk factors, and 30-day and long-term mortality of POAMI in noncardiac patients. The study protocol was registered with PROSPERO, CRD42023401607.
Ten cohorts containing 11,494 patients were included for analysis. The pooled incidence of POAMI was 20% (95% CI: 16% to 23%). Preoperative hypertension (OR: 1.47; 95% CI: 1.30 to 1.66), cardiac failure (OR: 2.63; 95% CI: 2.01 to 3.44), renal impairment (OR: 1.66; 95% CI: 1.48 to 1.86), diabetes (OR: 1.43; 95% CI: 1.27 to 1.61), and preoperative beta-blocker intake (OR: 1.65; 95% CI: 1.10 to 2.49) were the risk factors for POAMI. Age (mean difference: 2.08 years; 95% CI: -0.47 to 4.62), sex (male, OR: 1.16; 95% CI: 0.77 to 1.76), body mass index (mean difference: 0.35; 95% CI: -0.86 to 1.57), preoperative coronary artery disease (OR: 2.10; 95% CI: 0.85 to 5.21), stroke (OR: 0.90; 95% CI: 0.50 to 1.59) and preoperative statins intake (OR: 0.65; 95% CI: 0.21 to 2.02) were not associated with POAMI. Patients with POAMI had higher preoperative hsTnT levels (mean difference: 5.92 ng/L; 95% CI: 4.17 to 7.67) and lower preoperative hemoglobin levels (mean difference: -1.29 g/dL; 95% CI: -1.43 to -1.15) than patients without.
Based on this meta-analysis, approximately 1 in 5 of noncardiac patients develop POAMI. However, the lack of a universally recognized definition for POAMI, which incorporates diverse cardiac biomarkers and patient groups, poses a challenge in accurately characterizing its incidence, risk factors, and clinical outcomes.
非心脏手术后心肌损伤是常见的，与短期和长期发病率和死亡率有关。然而，由于定义不一致，目前尚不清楚术后急性心肌损伤（POAMI）的发生率和危险因素。
我们系统地搜索了 PubMed 和 Web of Science，以确定应用术前和术后心肌肌钙蛋白变化值来定义心脏损伤的研究。我们估计了非心脏患者 POAMI 的总发生率、危险因素以及 30 天和长期死亡率。该研究方案已在 PROSPERO 注册，CRD42023401607。
纳入了 10 项包含 11494 名患者的队列进行分析。POAMI 的总发生率为 20%（95%CI：16%至 23%）。术前高血压（OR：1.47；95%CI：1.30 至 1.66）、心力衰竭（OR：2.63；95%CI：2.01 至 3.44）、肾功能不全（OR：1.66；95%CI：1.48 至 1.86）、糖尿病（OR：1.43；95%CI：1.27 至 1.61）和术前β受体阻滞剂的使用（OR：1.65；95%CI：1.10 至 2.49）是 POAMI 的危险因素。年龄（平均差异：2.08 岁；95%CI：-0.47 至 4.62）、性别（男性，OR：1.16；95%CI：0.77 至 1.76）、体重指数（平均差异：0.35；95%CI：-0.86 至 1.57）、术前冠状动脉疾病（OR：2.10；95%CI：0.85 至 5.21）、中风（OR：0.90；95%CI：0.50 至 1.59）和术前他汀类药物的使用（OR：0.65；95%CI：0.21 至 2.02）与 POAMI 无关。发生 POAMI 的患者术前 hsTnT 水平更高（平均差异：5.92ng/L；95%CI：4.17 至 7.67），血红蛋白水平更低（平均差异：-1.29g/dL；95%CI：-1.43 至 -1.15）。
基于这项荟萃分析，大约每 5 名非心脏患者中就有 1 名发生 POAMI。然而，由于 POAMI 的定义不统一，包括各种心脏生物标志物和患者群体，这给准确描述其发生率、危险因素和临床结局带来了挑战。
