Nuttall Gregory A, Merren Michael P, Naranjo Julian, Portner Erica R, Ambrose Amanda R, Rihal Charanjit S
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2024 Aug 21;8(5):435-442. doi: 10.1016/j.mayocpiqo.2024.07.002. eCollection 2024 Oct.
To evaluate whether major adverse cardiac events (MACE) continue to be a major causative factor for mortality after noncardiac surgery.
We performed retrospective study of 75,410 adult noncardiac surgery patients at Mayo Clinic Rochester, between January 1, 2016, and May 4, 2018. Electronic medical records were reviewed and data collected on all deaths within 30 days (n=692 patients) of surgery. The incidence of death due to MACE was calculated.
Postoperative MACE occurred in 150 patients (21.4 events per 10,000 patients; 95% CI, 18.2-25.2 events per 10,000 patients) with most occurring within 3 days of surgery (n=113). Postoperative MACE events were associated with atrial fibrillation with rapid rate response in 25 patients (16.7%), sepsis in 15 patients (10%), and bleeding in 15 patients (10%). There were 12 intraoperative deaths of which 9 were due to exsanguination (75%) and the remaining 3 (25%) due to cardiac arrest. Of the 56 deaths on the first 24 hours after surgery, 7 were due to hemorrhage, 17 due to cardiovascular causes, 20 due to sepsis, and 7 due to neurologic disease. The leading cause of total death over 30 days postoperatively was sepsis (28%), followed by malignancy (27%), cardiovascular disease (12%) neurologic disease (12%), and hemorrhage (5%).
MACE was not the leading cause of death both intraoperatively and postoperatively.
评估主要不良心脏事件（MACE）是否仍然是非心脏手术后死亡的主要原因。
我们对2016年1月1日至2018年5月4日在梅奥诊所罗切斯特分院接受非心脏手术的75410例成年患者进行了回顾性研究。回顾电子病历并收集手术30天内所有死亡患者（n = 692例）的数据。计算因MACE导致的死亡率。
术后发生MACE的患者有150例（每10000例患者中发生21.4例；95%CI，每10000例患者中发生18.2 - 25.2例），大多数发生在术后3天内（n = 113例）。术后MACE事件与快速心率反应性房颤相关的有25例（16.7%），脓毒症相关的有15例（10%），出血相关的有15例（10%）。术中死亡12例，其中9例死于失血（75%），其余3例（25%）死于心脏骤停。术后24小时内死亡的56例患者中，7例死于出血，17例死于心血管原因，20例死于脓毒症，7例死于神经系统疾病。术后30天内总死亡的主要原因是脓毒症（28%），其次是恶性肿瘤（27%）、心血管疾病（12%）、神经系统疾病（12%）和出血（5%）。
MACE并非术中和术后死亡的主要原因。
