Departments of Anesthesiology and Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Provincial Research Data Services (Alberta Health Services), Data and Research Services (Alberta SPOR SUPPORT Unit), Edmonton, AB, Canada.
Ann Surg. 2023 Dec 1;278(6):e1192-e1197. doi: 10.1097/SLA.0000000000005975. Epub 2023 Jul 17.
The objective of this study was to determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in major general surgery patients.
MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in major general surgical patients have not been described.
This was an international prospective cohort study of a representative sample of 22,552 noncardiac surgery patients 45 years or older, of whom 4490 underwent major general surgery in 24 centers in 13 countries. All patients had fifth-generation plasma high-sensitivity troponin T (hsTnT) concentrations measured during the first 3 postoperative days. MINS was defined as a hsTnT of 20-65 ng/L and absolute change >5 ng/L or hsTnT ≥65 ng/L secondary to ischemia. The objectives of the present study were to determine (1) whether MINS is prognostically important in major general surgical patients, (2) the clinical characteristics of major general surgical patients with and without MINS, (3) the 30-day outcomes for major general surgical patients with and without MINS, and (4) the proportion of MINS that would have gone undetected without routine postoperative monitoring.
The incidence of MINS in the major general surgical patients was 16.3% (95% CI, 15.3-17.4%). Thirty-day all-cause mortality in the major general surgical cohort was 6.8% (95% CI, 5.1%-8.9%) in patients with MINS compared with 1.2% (95% CI, 0.9%-1.6%) in patients without MINS ( P <0.01). MINS was independently associated with 30-day mortality in major general surgical patients (adjusted odds ratio 4.7, 95% CI, 3.0-7.4). The 30-day mortality was higher both among MINS patients with no ischemic features (ie, no ischemic symptoms or electrocardiogram findings) (5.4%, 95% CI, 3.7%-7.7%) and among patients with 1 or more clinical ischemic features (10.6%, 95% CI, 6.7%-15.8%). The proportion of major general surgical patients who had MINS without ischemic symptoms was 89.9% (95% CI, 87.5-92.0).
Approximately 1 in 6 patients experienced MINS after major general surgery. MINS was independently associated with a nearly 5-fold increase in 30-day mortality. The vast majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.
本研究旨在确定非心脏手术后心肌损伤（MINS）与主要普通外科患者的预后相关性、临床特征和 30 天结局。
MINS 与非心脏手术后 30 天死亡率独立相关。尚未描述主要普通外科患者中 MINS 的特征和预后重要性。
这是一项国际前瞻性队列研究，纳入了 22552 名年龄在 45 岁或以上的非心脏手术患者，其中 4490 名在 13 个国家的 24 个中心接受了主要普通外科手术。所有患者在术后第 1 至 3 天内均测量了第五代血浆高敏肌钙蛋白 T（hsTnT）浓度。MINS 的定义为 hsTnT 为 20-65ng/L，且绝对值增加>5ng/L 或 hsTnT≥65ng/L 继发于缺血。本研究的目的是确定：（1）MINS 在主要普通外科患者中是否具有预后意义；（2）有无 MINS 的主要普通外科患者的临床特征；（3）有无 MINS 的主要普通外科患者的 30 天结局；（4）不进行常规术后监测时会漏诊多少 MINS。
主要普通外科患者中 MINS 的发生率为 16.3%（95%CI，15.3-17.4%）。MINS 患者的主要普通外科队列 30 天全因死亡率为 6.8%（95%CI，5.1%-8.9%），而无 MINS 患者为 1.2%（95%CI，0.9%-1.6%）（P<0.01）。MINS 与主要普通外科患者的 30 天死亡率独立相关（调整比值比 4.7，95%CI，3.0-7.4）。既无缺血症状（即无缺血症状或心电图发现）又无 1 个或多个临床缺血特征的 MINS 患者（5.4%，95%CI，3.7%-7.7%）和有 1 个或多个临床缺血特征的 MINS 患者（10.6%，95%CI，6.7%-15.8%）的 30 天死亡率更高。无缺血症状的主要普通外科患者中发生 MINS 的比例为 89.9%（95%CI，87.5-92.0）。
约 1/6 的患者在接受主要普通外科手术后出现 MINS。MINS 与 30 天死亡率增加近 5 倍独立相关。大多数发生 MINS 的患者无症状，如果不常规进行术后肌钙蛋白测量，这些患者将被漏诊。
