Barra D'Or Hospital, Rio de Janeiro, Brazil; Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Am J Cardiol. 2023 Oct 1;204:70-76. doi: 10.1016/j.amjcard.2023.07.044. Epub 2023 Aug 2.
Myocardial injury after noncardiac surgery (MINS) increases mortality within 30 days. We aimed to evaluate the long-term impact of myocardial injury in a large cohort of patients admitted to intensive care after noncardiac surgery. All patients who stayed, at least, overnight with measurement of high-sensitive cardiac troponin were included. Clinical characteristics and occurrence of MINS were assessed between patients who died and survivors using chi-square test and Student t test. Variables with p <0.01 in the univariate model were included in the Cox regression model to identify predictor variables. Survival decision tree (SDT), a machine learning model, was also used to find the predictors and their correlations. We included 2,230 patients with mean age of 63.8±16.3 years, with most (55.6%) being women. The prevalence of MINS was 9.4% (209 patients) and there were 556 deaths (24.9%) in a median follow-up of 6.7 years. Univariate analysis showed variables associated with late mortality, namely: MINS, arterial hypertension, previous myocardial infarction, atrial fibrillation, dementia, urgent surgery, peripheral artery disease (PAD), chronic health status, and age. These variables were included in the Cox regression model and SDT. The predictor variables of all-cause death were MINS (hazard ratio [HR] 2.21; 95% confidence interval [CI] 1.77 to 2.76), previous myocardial infarction (HR 1.47; 95% CI 1.14 to 1.89); urgent surgery (HR 1.24; 95% CI 1.01 to 1.52), PAD (HR 1.83; 95% CI 1.23 to 2.73), dementia (HR 2.54; 95% CI 1.86 to 3.46) and age (HR 1.05; 95% CI 1.04 to 1.06). SDT had the same predictors, except PAD. In conclusion, increased high-sensitive troponin levels in patients who underwent noncardiac surgery raised the risk of short and late mortality.
非心脏手术后的心肌损伤（MINS）会增加 30 天内的死亡率。我们旨在评估大量接受非心脏手术后入住重症监护病房的患者心肌损伤的长期影响。所有至少过夜并测量高敏肌钙蛋白的患者均被纳入研究。使用卡方检验和学生 t 检验评估死亡患者和幸存者之间的临床特征和 MINS 的发生情况。单变量模型中 p 值<0.01 的变量被纳入 Cox 回归模型以确定预测变量。生存决策树（SDT），一种机器学习模型，也被用于寻找预测因子及其相关性。我们纳入了 2230 名平均年龄为 63.8±16.3 岁的患者，其中大多数（55.6%）为女性。MINS 的患病率为 9.4%（209 名患者），中位随访 6.7 年后有 556 例死亡（24.9%）。单变量分析显示与晚期死亡率相关的变量，即：MINS、动脉高血压、既往心肌梗死、心房颤动、痴呆、紧急手术、外周动脉疾病（PAD）、慢性健康状况和年龄。这些变量被纳入 Cox 回归模型和 SDT。全因死亡的预测变量为 MINS（风险比 [HR] 2.21；95%置信区间 [CI] 1.77 至 2.76）、既往心肌梗死（HR 1.47；95% CI 1.14 至 1.89）；紧急手术（HR 1.24；95% CI 1.01 至 1.52）、PAD（HR 1.83；95% CI 1.23 至 2.73）、痴呆（HR 2.54；95% CI 1.86 至 3.46）和年龄（HR 1.05；95% CI 1.04 至 1.06）。SDT 具有相同的预测因子，除了 PAD。总之，接受非心脏手术的患者中高敏肌钙蛋白水平升高会增加短期和晚期死亡的风险。
