Morbidity and Mortality After Acute Myocardial Infarction After Elective Major Noncardiac Surgery.
Morbidity and Mortality After Acute Myocardial Infarction After Elective Major Noncardiac Surgery.
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择期重大非心脏手术后急性心肌梗死的发病率和死亡率。
DOI：
10.1053/j.jvca.2020.10.016
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发表时间：
2021-03
影响因子：
2.8
通讯作者：
Rubin DS
中科院分区：
文献类型：
--
作者：
Ranjeva SL;Tung A;Nagele P;Rubin DS
目的：建立急性心肌梗死（AMI）围手术期住院死亡率和发病风险的简约模型。回顾性数据分析。全国住院病人样本（2008 - 2013），美国所有非联邦住院病人住院的20%样本。年龄在45岁及以上的非心脏手术患者在择期住院期间发生AMI。我们使用混合主成分分析和多变量logistic回归来确定AMI围手术期住院死亡率的危险因素。我们比较了一个仅包含术前危险因素的模型，该模型由修订心脏危险指数（RCRI）术前风险定义，与一个包含大量术前AMI危险因素的“全危险因素”模型。然后，我们评估ami后处置到中间护理机构或熟练护理机构的风险，这是功能损伤的标志。我们确定了15574例选择性非心脏手术后AMI（0.42%，相当于全国78,122例），住院死亡率为12.4%。“仅rcri”模型是ami后住院死亡风险的最佳拟合模型，与“全风险因素”模型（AUC）相比，预测准确性没有下降。80, 95% CI [0.77, 0.82] vs. AUC 0.81, 95% CI[0.77, 0.83])。脓毒症等围手术期并发症导致ami后死亡风险最高（OR 4.95, 95% CI[4.32, 5.67]）。相反，“完全危险因素”模型最能预测功能损害，并且在很大程度上依赖于慢性术前合并症。RCRI为AMI围手术期院内死亡的术前危险因素提供了一个简单而充分的模型。
To develop parsimonious models of in-hospital mortality and morbidity risk after perioperative acute myocardial infarction (AMI). Retrospective data analysis. National Inpatient Sample (2008 – 2013), a 20% sample of all non-federal in-patient hospitalizations in the United States. Patients aged 45 years or older who experienced perioperative AMI during elective admission for non-cardiac surgery. We used mixed principal components analysis and multivariable logistic regression to identify risk factors for in-hospital mortality after perioperative AMI. We compared a model incorporating only pre-operative risk factors defined by the Revised Cardiac Risk Index (RCRI) preoperative risk to a “full risk factor” model incorporating a large set of preoperative AMI risk factors. We then evaluated the risk of post-AMI disposition to an intermediate care or skilled nursing facility, a marker of functional impairment. We identified 15,574 cases of AMI after elective non-cardiac surgery (0.42%, corresponding to 78,122 cases nationally), with a 12.4% in-hospital mortality rate. The “RCRI-only” model was the best-fit model of post-AMI in-hospital mortality risk, without loss of predictive accuracy compared to the “full risk factor” model (AUC .80, 95% CI [0.77, 0.82] vs. AUC 0.81, 95% CI [0.77, 0.83], respectively). Post-AMI mortality risk was highest for peri-operative complications including sepsis (OR 4.95, 95% CI [4.32, 5.67]). Conversely, functional impairment was best predicted by the “full risk factor” model and depended strongly on chronic preoperative comorbidities. The RCRI provides a simple but adequate model of pre-operative risk factors for in-hospital mortality after peri-operative AMI.
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DOI：
10.1007/s12630-013-9988-5
发表时间：
2013-09-01
影响因子：
4.2
作者：
Davis, Christopher;Tait, Gordon;Beattie, W. Scott
通讯作者：
Beattie, W. Scott
影响因子：
--
作者：
Drosatos, Konstantinos;Lymperopoulos, Anastasios;Kennel, Peter Johannes;Pollak, Nina;Schulze, P Christian;Goldberg, Ira J
通讯作者：
Goldberg, Ira J
影响因子：
7.1
作者：
Kakihana Y;Ito T;Nakahara M;Yamaguchi K;Yasuda T
通讯作者：
Yasuda T
DOI：
10.1001/jama.2017.17653
发表时间：
2017-11-28
期刊：
JAMA
影响因子：
--
作者：
Khera R;Angraal S;Couch T;Welsh JW;Nallamothu BK;Girotra S;Chan PS;Krumholz HM
通讯作者：
Krumholz HM
影响因子：
6.2
作者：
Duceppe, Emmanuelle;Parlow, Joel;Devereaux, P. J.
通讯作者：
Devereaux, P. J.