Risk of Surgery Following Recent Myocardial Infarction
Risk of Surgery Following Recent Myocardial Infarction
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DOI：
10.1097/sla.0b013e3182125196
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发表时间：
2011-05-01
影响因子：
9
通讯作者：
de Virgilio, Christian
中科院分区：
文献类型：
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作者：
Livhits, Masha;Ko, Clifford Y.;de Virgilio, Christian
目标：我们的目的是评估近期心肌梗死（MI）对当代临床环境中后续手术后结局的影响。背景：既往研究表明，近期MI病史是非心脏手术后并发症的危险因素。然而，这一数据并不能反映当前的进展，在临床management.Methods：使用加州患者出院数据库，我们回顾性分析患者接受髋关节手术，胆囊切除术，结肠切除术，选择性腹主动脉瘤修复术，下肢截肢，从1999年至2004年（n = 563,842）。采用单变量分析和多变量logistic回归分析，比较近期有和无心肌梗死患者的术后30天心肌梗死率、30天死亡率和1年死亡率。使用重复1000次的自举法估计相对风险（RR）和95%置信区间。结果：近期MI队列的术后MI发生率随着MI至手术时间的延长而显著降低（0-30天= 32.8%，31-60天= 18.7%，61-90天= 8.4%，91-180天= 5.9%），30天死亡率也是如此（0-30天= 14.2%，31-60天= 11.5%，61-90天= 10.5%，91-180天= 9.9%）。手术后30天内发生心肌梗死与术后心肌梗死的风险较高（5种手术的RR范围为9.98-44.29）、30天死亡率（RR范围为1.83-3.84）和1年死亡率（RR范围为1.56-3.14）相关。应考虑延迟择期手术至少8周和医疗优化等策略。
Objective: We aimed to assess the impact of recentmyocardial infarction (MI) on outcomes after subsequent surgery in the contemporary clinical setting.Background: Prior work shows that a history of a recent MI is a risk factor for complications following noncardiac surgery. However, this data does not reflect current advances in clinical management.Methods: Using the California Patient Discharge Database, we retrospectively analyzed patients undergoing hip surgery, cholecystectomy, colectomy, elective abdominal aortic aneurysm repair, and lower extremity amputation from 1999 to 2004 (n = 563,842). Postoperative 30-day MI rate, 30-day mortality, and 1-year mortality were compared for patients with and without a recent MI using univariate analyses and multivariate logistic regression. Relative risks (RR) with 95% confidence intervals were estimated using bootstrapping with 1000 repetitions.Results: Postoperative MI rate for the recent MI cohort decreased substantially as the length of time from MI to operation increased (0-30 days = 32.8%, 31-60 days = 18.7%, 61-90 days = 8.4%, and 91-180 days = 5.9%), as did 30-day mortality (0-30 days = 14.2%, 31-60 days = 11.5%, 61-90 days = 10.5%, and 91-180 days = 9.9%). MI within 30 days of an operation was associated with a higher risk of postoperative MI (RR range = 9.98-44.29 for the 5 procedures), 30-day mortality (RR range, 1.83-3.84), and 1-year mortality (RR range, 1.56-3.14).Conclusions: A recent MI remains a significant risk factor for postoperative MI and mortality following surgery. Strategies such as delaying elective operations for at least 8 weeks and medical optimization should be considered.