Characteristics and Outcomes of Type 1 versus Type 2 Perioperative Myocardial Infarction After Noncardiac Surgery.
Characteristics and Outcomes of Type 1 versus Type 2 Perioperative Myocardial Infarction After Noncardiac Surgery.
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DOI：
10.1016/j.amjmed.2021.08.028
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Berger JS
中科院分区：
文献类型：
--
作者：
Smilowitz NR;Shah B;Ruetzler K;Garcia S;Berger JS
围术期心肌梗死通常归因于2型心肌梗死，这是一种没有不稳定冠状动脉疾病的心肌氧供需不匹配。我们的目的是确定在美国住院的外科患者围手术期1型心肌梗死与2型心肌梗死的特点、处理和结果。在美国确定了年龄为45岁的≥因非心脏手术住院的成年人。使用ICD-10编码识别围手术期心肌梗死。根据心肌梗死亚型评估临床特征、侵袭性心肌梗死治疗、死亡率和再入院情况。在4,755,382例外科住院患者中，我们发现了38,975例围手术期心肌梗死(0.82%)，其中2型心肌梗死占42%。与1型心肌梗死相比，2型心肌梗死患者年龄更大，更有可能是女性，并且不太可能有心血管并发症。接受侵入性治疗的2型心肌梗死患者比1型心肌梗死患者少(6.7%比28.8%，p<；0.001)。2型心肌梗死死亡率低于1型心肌梗死死亡率(12.1%vs.17.4%，p<；0.001；调整OR0.51，95%CI0.45-0.59)。围术期心肌梗死的介入治疗与1型(AOR 0.56，95%CI 0.49~0.74)的低死亡率相关，而与2型(AOR 1.19，95%CI 0.77~1.85)心肌梗死无关。在幸存者中，2型和1型围手术期心肌梗死患者的90天再住院率没有差异(36.5%比36.1%，p=0.72)。2型心肌梗死约占围手术期心肌梗死的40%。与1型围手术期心肌梗死患者相比，2型围手术期心肌梗死患者接受侵入性治疗的可能性较小，死亡率也较低。
Perioperative myocardial infarction is frequently attributed to type 2 myocardial infarction, a mismatch in myocardial oxygen supply-demand without unstable coronary artery disease. Our aim was to identify characteristics, management, and outcomes of perioperative type 1 versus type 2 myocardial infarction among surgical patients hospitalized in the United States. Adults age ≥45 years hospitalized for non-cardiac surgery were identified in the United States. Perioperative myocardial infarction were identified using ICD-10 codes. Clinical characteristics, invasive myocardial infarction management, mortality, and readmissions were assessed by myocardial infarction subtype. Among 4,755,382 surgical hospitalizations, we identified 38,975 perioperative myocardial infarctions (0.82%), with type 2 infarction in 42%. Patients with type 2 myocardial infarction were older, more likely to be women, and less likely to have cardiovascular comorbidities compared with type 1 myocardial infarction. Fewer patients with type 2 myocardial infarction underwent invasive management than type 1 myocardial infarction (6.7% vs. 28.8%, p<0.001). Type 2 myocardial infarction mortality was lower than type 1 myocardial infarction mortality (12.1% vs. 17.4%, p<0.001; adjusted OR 0.51, 95% CI 0.45–0.59). Invasive management of perioperative myocardial infarction was associated with lower mortality in type 1 (aOR 0.56, 95% CI 0.49–0.74) but not type 2 (aOR 1.19, 95% CI 0.77–1.85) myocardial infarction. Among survivors, there was no difference in 90-day hospital readmission between type 2 and type 1 perioperative myocardial infarction (36.5% vs. 36.1%, p=0.72). Type 2 myocardial infarctions account for ~40% of perioperative myocardial infarctions. Patients with type 2 perioperative myocardial infarction are less likely to undergo invasive management and have lower mortality compared to those with type 1 perioperative myocardial infarction.
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