Charlson M, Peterson J, Szatrowski T P, MacKenzie R, Gold J
Department of Medicine, Cornell Arthritis and Musculoskeletal Disease Center, Hospital for Special Surgery, New York, NY, U.S.A.
J Clin Epidemiol. 1994 Dec;47(12):1389-400. doi: 10.1016/0895-4356(94)90083-3.
The objective was to document the 5 year prognosis of patients who had cardiac complications after non-cardiac surgery.
5-year follow-up of 218 patients originally enrolled in a prospective study to identify risks factors for peri-operative complications.
an academic medical center. Participants were hypertensives and diabetics who underwent elective surgery between 1982 and 1985. In the original study, patients were evaluated pre-operatively, monitored intra-operatively by an independent observer, and followed daily for 7 days post-operatively according to a standard surveillance protocol. Outcomes were judged by assessors blinded to the pre-operative status and intra-operative course. Patients were interviewed at 3 and 5 years post-operatively. Patients with post-operative cardiac complications had significantly higher rates of overall mortality, mortality attributable to cardiac causes (MI, CHF, arrest), and mortality attributable to other cardiovascular causes (stroke, renal failure) than patients without cardiac complications. For example, at 5 years 11% of those patients without post-operative cardiac complications had cardiac deaths, in contrast to 45% of those patients with post-operative cardiac complications. Proportional hazards analysis demonstrated that post-operative cardiac complications remained a significant predictor of cardiac (p < 0.001) and cardiovascular (p < 0.0001) mortality controlling for pre-operative cardiac disease, other non-cardiovascular comorbid diseases, age, sex, diabetes, and pre-operative renal insufficiency or stroke. Similarly, patients with post-operative non-fatal cardiac complications had higher rates of cardiac or cardiovascular events during the 5 year follow-up period. We conclude that post-operative cardiac complications have a significant adverse long-term prognostic impact comparable to the prognostic impact of myocardial infarction, ischemia or congestive failure in the non-operative setting. Understanding these events could be an important factor in identifying patients at high risk for subsequent peri-operative complications.
目的是记录非心脏手术后发生心脏并发症患者的5年预后情况。
对最初纳入一项前瞻性研究以确定围手术期并发症风险因素的218例患者进行5年随访。
一家学术医疗中心。参与者为1982年至1985年间接受择期手术的高血压和糖尿病患者。在最初的研究中，患者在术前接受评估，术中由独立观察者进行监测，并根据标准监测方案在术后每天随访7天。结果由对术前状态和术中过程不知情的评估者判断。在术后3年和5年对患者进行访谈。与无心脏并发症的患者相比，术后发生心脏并发症的患者总体死亡率、心脏原因（心肌梗死、心力衰竭、心脏骤停）导致的死亡率以及其他心血管原因（中风、肾衰竭）导致的死亡率显著更高。例如，在5年时，无术后心脏并发症的患者中有11%发生心源性死亡，相比之下，有术后心脏并发症的患者中这一比例为45%。比例风险分析表明，控制术前心脏病、其他非心血管合并症、年龄、性别、糖尿病以及术前肾功能不全或中风后，术后心脏并发症仍是心脏（p < 0.001）和心血管（p < 0.
