Myocardial infarction and cerebrovascular accident following non-cardiac surgery: differences in postoperative temporal distribution and risk factors
Myocardial infarction and cerebrovascular accident following non-cardiac surgery: differences in postoperative temporal distribution and risk factors
复制标题
DOI：
10.1111/j.1538-7836.2008.02948.x
复制
发表时间：
2008-05-01
影响因子：
10.4
通讯作者：
Landesberg, G.
中科院分区：
文献类型：
--
作者：
Kikura, M.;Oikawa, F.;Landesberg, G.
背景资料：非心脏手术后的心肌梗死和卒中是两种被认为具有相似病理生理过程的不祥的心血管并发症。然而，他们之间的时间分布的差异还没有得到充分的研究，在一个大的患者队列。方法和结果：在36634例择期非心脏、非颈动脉手术后的连续患者中，常规记录术前临床特征和心肌梗死和卒中的每日发生率。采用指数和线性回归模型比较术后心肌梗死和卒中的术前特征和术后每日分布。在术后的前30天内，分别有122例（0.33%）和126例（0.34%）患者发生心肌梗死和卒中。心肌梗死患者中糖尿病和心脏病患者较多（分别为P = 0.041和< 0.0001），而卒中患者中老年人和女性较多（分别为P = 0.003和0.038）。心肌梗死发生率在手术当天最高（43%），此后呈指数下降（F = 725.4，P < 0.0001）。然而，术后卒中最适合线性回归，几乎每天均匀分布（F = 15.9，P = 0.0004）。发生心肌梗死的中位时间为1天[95%置信区间（95% CI）= 0-2天]，而发生卒中的中位时间为9天（95% CI = 7-11天）。结论：术后心肌梗死的发病率高峰出现在非心脏手术后的早期，此后呈指数下降，而中风则在术后期间以恒定的速度发生。非心脏手术后心肌梗死和脑血管意外的术前危险因素和术后发生时间不同。
Background: Myocardial infarction and stroke after non-cardiac surgery are two ominous cardiovascular complications believed to share similar pathophysiological processes. However, the differences in the temporal distribution between them have not been adequately investigated in a large cohort of patients. Methods and Results: The preoperative clinical features and daily occurrence of myocardial infarction and stroke were routinely recorded in 36 634 consecutive patients following elective non-cardiac, non-carotid surgery. The preoperative characteristics and postoperative daily distribution of postoperative myocardial infarction and stroke were compared using exponential and linear regressions models. Myocardial infarction and stroke occurred in 122 (0.33%) and 126 (0.34%) patients, respectively, during the first 30 days after surgery. More patients with myocardial infarction had diabetes mellitus and cardiac disease (P = 0.041 and < 0.0001, respectively) whereas more patients with stroke were older and female (P = 0.003 and 0.038, respectively). The peak incidence of myocardial infarction was on the day of surgery (43%) and declined exponentially thereafter (F = 725.4, P < 0.0001). However, postoperative stroke best fitted a linear regression with almost even daily distribution (F = 15.9, P = 0.0004). The median time to myocardial infarction was one day [95% confidence interval (95% CI) = 0-2 days] compared with nine days (95% CI = 7-11 days) for stroke. Conclusions: The peak incidence of postoperative myocardial infarction is early after non-cardiac surgery and declines exponentially thereafter, as opposed to stroke, which occurs at a constant rate during the postoperative period. Myocardial infarction and cerebrovascular accident following non-cardiac surgery differ in their preoperative risk factors, and in the postoperative time-line of their occurrence.