Kirkopoulos Anna, M'Pembele René, Roth Sebastian, Stroda Alexandra, Larmann Jan, Gillmann Hans-Joerg, Kotfis Katarzyna, Ganter Michael T, Bolliger Daniel, Filipovic Miodrag, Guzzetti Luca, Mauermann Eckhard, Ionescu Daniela, Spadaro Savino, Szczeklik Wojciech, De Hert Stefan, Beck-Schimmer Beatrice, Howell Simon J, Lurati Buse Giovanna A
Anesthesiology Department, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
Anaesthesia. 2025 Aug;80(8):927-934. doi: 10.1111/anae.16607. Epub 2025 Apr 15.
Heart failure is a frequent comorbidity in patients undergoing non-cardiac surgery and an acknowledged risk factor for postoperative mortality. The associations between stable chronic heart failure and postoperative outcomes have not been explored extensively. The aim of this study was to determine associations between stable chronic heart failure and its peri-operative management and postoperative outcomes after major non-cardiac surgery.
This is a secondary analysis of MET-REPAIR, an international prospective cohort study including patients undergoing non-cardiac surgery aged ≥ 45 y with increased cardiovascular risk. Main exposures were stable chronic heart failure and availability of a pre-operative transthoracic echocardiogram. The primary endpoint was the incidence of postoperative major adverse cardiovascular events at 30 days. Secondary endpoints included 30-day mortality and severe in-hospital complications. Multivariable logistic regression models were calculated.
Of 15,158 included patients, 3880 (25.6%) fulfilled the diagnostic criteria for stable chronic heart failure, of whom 1397 (36%) were female. Chronic heart failure was associated with increased risk of postoperative 30-day major adverse cardiovascular events (OR 2.04, 95%CI 1.59-2.60), 30-day mortality (OR 1.50, 95%CI 1.17-1.92) and in-hospital complications (OR 1.47, 95%CI 1.30-1.66). Transthoracic echocardiography was performed in 1267 (32.7%) patients with heart failure; 146 (11.5%) patients with heart failure presented with a left ventricular ejection fraction < 40%. Reduced ejection fraction was associated with major adverse cardiovascular events (OR 2.0, 95%CI 1.01-3.81).
Stable chronic heart failure is independently associated with major adverse cardiovascular events, mortality and severe postoperative complications when measured 30 days after non-cardiac surgery.
心力衰竭是接受非心脏手术患者常见的合并症，也是公认的术后死亡风险因素。稳定型慢性心力衰竭与术后结局之间的关联尚未得到广泛研究。本研究的目的是确定稳定型慢性心力衰竭与其围手术期管理以及大型非心脏手术后的术后结局之间的关联。
这是对MET-REPAIR的二次分析，MET-REPAIR是一项国际前瞻性队列研究，纳入年龄≥45岁、心血管风险增加且接受非心脏手术的患者。主要暴露因素为稳定型慢性心力衰竭和术前经胸超声心动图检查的可用性。主要终点是术后30天主要不良心血管事件的发生率。次要终点包括30天死亡率和严重的院内并发症。计算多变量逻辑回归模型。
在纳入的15158例患者中，3880例（25.6%）符合稳定型慢性心力衰竭的诊断标准，其中1397例（36%）为女性。慢性心力衰竭与术后30天主要不良心血管事件风险增加（比值比2.04，95%置信区间1.59-2.60）、30天死亡率（比值比1.50，95%置信区间1.17-1.92）和院内并发症（比值比1.47，95%置信区间1.30-1.66）相关。1267例（32.7%）心力衰竭患者接受了经胸超声心动图检查；146例（11.5%）心力衰竭患者左心室射血分数<40%。射血分数降低与主要不良心血管事件相关（比值比2.0，95%置信区间1.01-3.
