Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea.
Open Heart. 2023 Aug;10(2). doi: 10.1136/openhrt-2023-002318.
Myocardial injury after non-cardiac surgery (MINS) has recently been accepted as a common complication associated with increased mortality. However, little is known about the treatment of MINS. The aim of this study was to investigate an association between antiplatelet therapy and long-term mortality after MINS.
From 2010 to 2019, patients with MINS, defined as having a peak high-sensitivity troponin I higher than 40 ng/L within 30 days after non-cardiac surgery, were screened at a tertiary centre. Patients were excluded if they had a history of coronary revascularisation before or during index hospitalisation. Clinical outcomes at 1 year were compared between patients with and without antiplatelet therapy at hospital discharge. The primary outcome was death, and the secondary outcome was major bleeding.
Of the 3818 eligible patients with MINS, 940 (24.6%) received antiplatelet therapy at hospital discharge. Patients with antiplatelet therapy had a significantly lower mortality at 1 year than those without antiplatelet therapy (7.5% vs 15.9%, adjusted HR 0.60, 95% CI 0.45 to 0.79, p<0.001). A risk of major bleeding at 1 year was not significantly different between the patients with and without antiplatelet therapy (6.6% vs 7.6%, adjusted HR 0.85, 95% CI 0.62 to 1.17, p=0.324). In propensity score-matched analysis of 886 pairs, patients with antiplatelet therapy had a significantly lower risk of 1-year mortality (adjusted HR 0.53, 95% CI 0.39 to 0.73, p<0.001) than those without antiplatelet therapy.
In patients with MINS, antiplatelet therapy at discharge was associated with decreased 1-year mortality.
非心脏手术后心肌损伤（MINS）最近被认为是与死亡率增加相关的常见并发症。然而，对于 MINS 的治疗方法知之甚少。本研究旨在探讨抗血小板治疗与 MINS 后长期死亡率之间的关系。
2010 年至 2019 年，在一家三级中心筛选出 MINS 患者，定义为非心脏手术后 30 天内肌钙蛋白 I 峰值高于 40ng/L。如果患者在指数住院期间或之前有冠状动脉血运重建史，则将其排除在外。比较出院时接受和未接受抗血小板治疗的患者在 1 年时的临床结局。主要结局是死亡，次要结局是大出血。
在 3818 例符合条件的 MINS 患者中，940 例（24.6%）在出院时接受了抗血小板治疗。与未接受抗血小板治疗的患者相比，接受抗血小板治疗的患者在 1 年时的死亡率显著降低（7.5% vs 15.9%，调整后的 HR 0.60，95%CI 0.45 至 0.79，p<0.001）。1 年内大出血的风险在接受和未接受抗血小板治疗的患者之间无显著差异（6.6% vs 7.6%，调整后的 HR 0.85，95%CI 0.62 至 1.17，p=0.324）。在 886 对倾向评分匹配分析中，接受抗血小板治疗的患者 1 年死亡率显著降低（调整后的 HR 0.53，95%CI 0.39 至 0.73，p<0.001）。
在 MINS 患者中，出院时的抗血小板治疗与降低 1 年死亡率相关。
