Tang Tian-Ying, Liu Jia-Ming, Liu Hua-Min, Zhang Jing, Zhang Fu, Zhao Bing-Cheng, Liu Ke-Xuan
Department of Anaesthesiology, Nanfang Hospital, Southern Medical University; The key Laboratory of Precision Anaesthesia & perioperative Organ Protection, Guangzhou, Guangdong, China.
School of Nursing, Southern Medical University, Guangzhou, China.
Ann Med. 2025 Dec;57(1):2552936. doi: 10.1080/07853890.2025.2552936. Epub 2025 Sep 2.
Myocardial injury after noncardiac surgery (MINS) is associated with poor prognosis. The effect of different occurrence time of MINS on long-term functional capacity remains unclear in population with high cardiovascular risk.
This cohort study included adult patients with increased cardiovascular risk undergoing elective major noncardiac surgery from June 2019 to September 2021. Patients with MINS were stratified in two groups on the basis of the occurrence time of MINS: within 24 hour (h) or after 24 h. The primary endpoint was disability at 180 days after surgery, evaluated by World Health Organization Disability Assessment Schedule 2.0. Disability was defined as ≥25% or an increase of 8%. Multivariable logistic regression was adopted to explore the association between occurrence time of MINS and primary endpoint. Propensity score weighting, including inverse probability weighting and overlap weighting, and subgroup analysis were used to explore the relationship further.
2469 participants were included, of which 178 (7.2%) participants developed MINS within 24 h and 83 (3.4%) after 24 h. A total of 378 (15.3%) participants developed disability at 180 days after surgery, with an unweighted odds ratio (OR) of 1.97 (95% confidence intervals [CIs]: 1.17-3.32) for patients who suffered MINS after 24 h and weighted OR of 2.25 (95%CIs: 1.10-4.63) and 2.11 (95%CIs: 1.23-3.63) by IPW and OW, respectively. Findings were conserved in the subgroup analysis.
MINS occurring after 24 h was associated with worsen long-term functional capacity after surgery, whereas MINS occurring within 24 h was not.
非心脏手术后心肌损伤（MINS）与预后不良相关。在心血管风险较高的人群中，MINS不同发生时间对长期功能能力的影响尚不清楚。
这项队列研究纳入了2019年6月至2021年9月期间接受择期非心脏大手术且心血管风险增加的成年患者。根据MINS的发生时间，将发生MINS的患者分为两组：24小时内或24小时后。主要终点是术后180天的残疾情况，采用世界卫生组织残疾评估量表2.0进行评估。残疾定义为≥25%或增加8%。采用多变量逻辑回归分析探讨MINS发生时间与主要终点之间的关联。倾向评分加权，包括逆概率加权和重叠加权，并进行亚组分析以进一步探讨两者关系。
共纳入2469名参与者，其中178名（7.2%）在24小时内发生MINS，83名（3.4%）在24小时后发生MINS。共有378名（15.3%）参与者在术后180天出现残疾，24小时后发生MINS的患者未加权比值比（OR）为1.97（95%置信区间[CI]：1.17 - 3.32），通过逆概率加权（IPW）和重叠加权（OW）的加权OR分别为2.25（95%CI：1.10 - 4.63）和2.11（95%CI：1.23 - 3.63）。亚组分析结果一致。
24小时后发生的MINS与术后长期功能能力恶化相关，而24小时内发生的MINS则不然。
