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心脏手术后的中风:对来自英国国家成人心脏手术审计队列的580117名患者的风险因素分析

Stroke after Cardiac Surgery: A Risk Factor Analysis of 580,117 Patients from UK National Adult Cardiac Surgical Audit Cohort.

作者信息

Asta Laura, Falco Daniele, Benedetto Umberto, Porreca Annamaria, Majri Fatma, Angelini Gianni D, Sensi Stefano, Di Giammarco Gabriele

机构信息

Department of Cardiac Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.

Division of Cardiac Surgery, SS Annunziata Hospital, 66100 Chieti, Italy.

出版信息

J Pers Med. 2024 Jan 31;14(2):169. doi: 10.3390/jpm14020169.


DOI:10.3390/jpm14020169
PMID:38392602
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10890399/
Abstract

Cerebrovascular accident is the most ominous complication observed after cardiac surgery, carrying an increased risk of morbidity and mortality. Analysis of the problem shows its multidimensional nature. In this study, we aimed to identify major determinants among classic variables, either demographic, clinical or type of surgical procedure, based on the analysis of a large dataset of 580,117 patients from the UK National Adult Cardiac Surgical Audit (NACSA). For this purpose, univariate and multivariate logistic regression models were utilized to determine associations between predictors and dependent variable (Stroke after cardiac surgery). Odds ratios (ORs) and 95% confidence intervals (CIs) were constructed for each independent variable. Statistical analysis allows us to confirm with greater certainty the predictive value of some variables such as age, gender, diabetes mellitus (diabetes treated with insulin OR = 1.37, 95%CI = 1.23-1.53), and systemic arterial hypertension (OR = 1.11, 95%CI = 1.05-1.16);, to emphasize the role of preoperative atrial fibrillation (OR = 1.10, 95%CI = 1.03-1.16) extracardiac arteriopathy (OR = 1.70, 95%CI = 1.58-1.82), and previous cerebral vascular accident (OR 1.71, 95%CI = 1.6-1.9), and to reappraise others like smoking status (crude OR = 1.00, 95%CI = 0.93-1.07 for current smokers) or BMI (OR = 0.98, 95%CI = 0.97-0.98). This could allow for better preoperative risk stratification. In addition, identifying those surgical procedures (for example thoracic aortic surgery associated with a crude OR of 3.72 and 95%CI = 3.53-3.93) burdened by a high risk of neurological complications may help broaden the field of preventive and protective techniques.

摘要

脑血管意外是心脏手术后观察到的最严重并发症,会增加发病和死亡风险。对该问题的分析显示出其多维度性质。在本研究中,我们旨在基于对来自英国国家成人心脏手术审计(NACSA)的580,117例患者的大型数据集的分析,确定经典变量(无论是人口统计学、临床还是手术类型)中的主要决定因素。为此,使用单变量和多变量逻辑回归模型来确定预测因素与因变量(心脏手术后中风)之间的关联。为每个自变量构建比值比(OR)和95%置信区间(CI)。统计分析使我们能够更确定地确认某些变量的预测价值,如年龄、性别、糖尿病(胰岛素治疗的糖尿病OR = 1.37,95%CI = 1.23 - 1.53)和系统性动脉高血压(OR = 1.11,95%CI = 1.05 - 1.16);强调术前心房颤动(OR = 1.10,95%CI = 1.03 - 1.16)、心脏外动脉病变(OR = 1.70,95%CI = 1.58 - 1.82)和既往脑血管意外(OR 1.71,95%CI = 1.6 - 1.9)的作用,并重新评估其他因素,如吸烟状况(当前吸烟者的粗OR = 1.00,95%CI = 0.93 - 1.07)或BMI(OR = 0.98,95%CI = 0.97 - 0.98)。这可以实现更好的术前风险分层。此外,识别那些神经并发症风险高的手术程序(例如胸主动脉手术,粗OR为3.72,95%CI = 3.53 - 3.93)可能有助于拓宽预防和保护技术的领域。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56f5/10890399/c0b0861391e1/jpm-14-00169-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56f5/10890399/c47ff6e84ad3/jpm-14-00169-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56f5/10890399/c0b0861391e1/jpm-14-00169-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56f5/10890399/c47ff6e84ad3/jpm-14-00169-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56f5/10890399/c0b0861391e1/jpm-14-00169-g002.jpg

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[1]
Stroke after Cardiac Surgery: A Risk Factor Analysis of 580,117 Patients from UK National Adult Cardiac Surgical Audit Cohort.

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Eur J Med Res. 2025-7-9

[2]
Acute Ischemic and Hemorrhagic Cerebrovascular Strokes After Cardiac Surgery: Incidence, Predictors, and Outcomes.

Crit Care Res Pract. 2025-4-30

[3]
Comparison of Sutureless and Sutured Aortic Valve Replacements in Patients with Redo Infective Endocarditis.

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[4]
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J Clin Med. 2024-5-21

本文引用的文献

[1]
Risk Factors Associated with Ischemic Stroke in the Immediate Postoperative Period of Cardiac Surgery.

Braz J Cardiovasc Surg. 2023-7-4

[2]
Stroke and mortality rates after off-pump vs. pump-assisted/no-clamp coronary artery bypass grafting.

J Cardiovasc Surg (Torino). 2022-12

[3]
Perioperative stroke: A perspective on challenges and opportunities for experimental treatment and diagnostic strategies.

CNS Neurosci Ther. 2022-4

[4]
Perioperative Stroke and Thirty-Day Hospital Readmission After Cardiac Surgeries: State Inpatient Database Study.

J Clin Med Res. 2022-1

[5]
Perioperative stroke and survival in coronary artery bypass grafting patients: a SWEDEHEART study.

Eur J Cardiothorac Surg. 2022-9-2

[6]
Rate Versus Rhythm Control in Heart Failure Patients with Post-Operative Atrial Fibrillation After Cardiac Surgery.

J Card Fail. 2021-8

[7]
Risk Score Elaboration for Stroke in Cardiac Surgery.

Braz J Cardiovasc Surg. 2021-12-3

[8]
Stroke in women: When gender matters.

Rev Neurol (Paris). 2021-10

[9]
Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study.

J Cardiothorac Surg. 2021-5-24

[10]
Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association.

Circulation. 2021-5-11

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