Alvarez Torres Eva, Bartoszko Justyna, Martinez Perez Selene, Tait Gordon, Santema Michael, Beattie W Scott, McCluskey Stuart A, van Klei Wilton A
Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2024 Mar;71(3):322-329. doi: 10.1007/s12630-023-02647-4. Epub 2023 Nov 16.
We aimed to evaluate the effect of the 2017 Canadian Cardiovascular Society (CCS) guidelines on troponin surveillance after noncardiac surgery.
This was a single-centre, retrospective, observational study. Patients aged 40 yr or older undergoing intermediate- to high-risk elective noncardiac surgery between 2016 and 2021 were included. We compared the number and percentage of troponin tests ordered before and after the guidelines were published and compared patient characteristics, specifically cardiovascular comorbidity, using odds ratio's (OR) with 95% confidence intervals (CIs). Outcomes were myocardial injury, myocardial infarction (MI), and in-hospital mortality.
The cohort included 36,386 patients and the median age was 63 yr. Between 2016 and 2018, troponin surveillance was done in 2,461 (13%) of the 19,046 patients, compared with 2,398 (14%) of the 17,340 patients who had surgery between 2019 and 2021 (OR, 1.08; 95% CI, 1.02 to 1.15). Patients who had surgery in the second period had less cardiovascular comorbidity; the adjusted OR for troponin surveillance was 1.14 (95% CI, 1.07 to 1.21). In the two periods, troponin was elevated in 561 (2.9%) and 470 (2.7%) patients, an MI was documented in 54 (0.3%) and 36 (0.2%) patients, and 95 (0.5%) and 73 (0.4%) patients died, respectively. After adjustment for baseline differences in the two periods, the ORs for MI and mortality were 0.83 (95% CI, 0.54 to 1.27) and 0.88 (95% CI, 0.64 to 1.19), respectively.
Although the odds of troponin ordering were slightly but significantly higher after publication of the CCS guidelines, the odds for detecting an MI and for mortality did not change.
我们旨在评估2017年加拿大心血管学会（CCS）指南对非心脏手术后肌钙蛋白监测的影响。
这是一项单中心、回顾性观察研究。纳入了2016年至2021年间年龄在40岁及以上接受中高危择期非心脏手术的患者。我们比较了指南发布前后肌钙蛋白检测的数量和百分比，并使用比值比（OR）及95%置信区间（CI）比较患者特征，特别是心血管合并症。结局指标为心肌损伤、心肌梗死（MI）和住院死亡率。
该队列包括36386例患者，中位年龄为63岁。2016年至2018年期间，19046例患者中有2461例（13%）进行了肌钙蛋白监测，而2019年至2021年期间进行手术的17340例患者中有2398例（14%）进行了监测（OR，1.08；95%CI，1.02至1.15）。第二阶段接受手术的患者心血管合并症较少；肌钙蛋白监测的校正OR为1.14（95%CI，1.07至1.21）。在两个阶段，分别有561例（2.9%）和470例（2.7%）患者肌钙蛋白升高，有54例（0.3%）和36例（0.2%）患者记录发生MI，分别有95例（0.5%）和73例（0.4%）患者死亡。在对两个阶段的基线差异进行校正后，MI和死亡率的OR分别为0.83（95%CI，0.54至1.27）和0.88（95%CI，0.64至1.19）。
尽管CCS指南发布后肌钙蛋白检测的几率略有但显著升高，但检测到MI和死亡率的几率并未改变。
