Kalra M, Charlesworth D, Morris J A, al-Khaffaf H
Department of Surgery, Withington Hospital, West Didsbury, Manchester, UK.
Br J Surg. 1993 Jan;80(1):28-31. doi: 10.1002/bjs.1800800110.
The records of 555 patients who underwent elective abdominal aortic reconstruction were analysed to identify risk factors predisposing to cardiac complications. Perioperative myocardial infarction occurred in 35 patients (6.3 per cent), of whom 12 (2.2 per cent) died. Using multiple logistic regression, four preoperative factors that were independently predictive for postoperative myocardial infarction were identified with the following relative risk ratios: history of transient ischaemic attacks, 5.08; raised serum creatinine level, 3.66; age > 60 years, 3.00; and angina requiring regular treatment, 2.74. A scoring system using these four factors was devised that identified 150 of the 555 patients as at high risk, and included 69 per cent of those with myocardial infarction after operation and 83 per cent of those who died. A clinical risk score is a practical first step in identifying patients at risk of myocardial infarction; it would also reduce the number of patients for whom sophisticated tests of cardiac function were necessary.
对555例行择期腹主动脉重建术患者的记录进行分析，以确定易导致心脏并发症的危险因素。围手术期心肌梗死发生在35例患者中（6.3%），其中12例（2.2%）死亡。采用多因素logistic回归分析，确定了四个术前独立预测术后心肌梗死的因素，其相对危险比分别为：短暂性脑缺血发作史，5.08；血清肌酐水平升高，3.66；年龄>60岁，3.00；以及需要常规治疗的心绞痛，2.74。利用这四个因素设计了一个评分系统，该系统在555例患者中识别出150例高危患者，其中包括术后发生心肌梗死患者的69%以及死亡患者的83%。临床风险评分是识别有心肌梗死风险患者的切实可行的第一步；它还将减少需要进行心脏功能复杂检测的患者数量。
