Association Between Antifibrinolytic Therapy and Perioperative Outcomes in Patients With Coronary Artery Stents Undergoing Noncardiac Surgery.
Association Between Antifibrinolytic Therapy and Perioperative Outcomes in Patients With Coronary Artery Stents Undergoing Noncardiac Surgery.
复制标题
接受非心脏手术的冠状动脉支架患者的抗纤溶治疗与围手术期结局之间的相关性。
DOI：
10.1213/ane.0000000000005522
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发表时间：
2021-06-01
影响因子：
5.7
通讯作者：
Smith BB
中科院分区：
文献类型：
--
作者：
Boswell MR;Smith MM;Frank RD;Brown MJ;Abcejo AS;Kor TM;Gulati R;Smith BB
现有冠状动脉支架患者在接受非心脏手术（NCS）时发生主要不良心脏事件（MACE）的风险增加。尽管在过去十年中NCS中抗纤溶（AF）治疗的使用显著增加，但在现有冠状动脉支架患者中，围手术期AF使用与其相关MACE之间的关系尚未评估。在本研究中，我们的目的是评价在骨科手术期间接受围手术期AF治疗的现有冠状动脉支架患者中MACE的相关性。在2008-2018年接受骨科手术的现有冠状动脉支架成人患者中进行了一项单中心回顾性队列研究。建立了两个队列：使用logistic回归模型分析AF使用与术后30天内MACE的主要结局以及血栓性并发症、手术出血过多和ICU入院的次要结局之间的关系。使用治疗加权的逆概率控制混杂因素。使用未调整的逻辑回归模型进行次要分析，检查冠状动脉支架类型/时间与关注结局之间的相关性。473例患者符合研究标准，包括294例未接受AF的患者和179例接受AF的患者。15例（5.1%）未接受AF的患者和1例（0.6%）接受AF的患者发生MACE（p=0.007）。在加权分析中，未发现接受AF的患者在MACE方面存在显著差异（OR 0.13，95% CI=0.01-1.74，p=0.12），血栓性并发症（OR 1.19，95% CI=0.53-2.68，p=0.68）或手术出血过多（OR 0.13，95% CI=0.01-2.23，p=0.16）与未接受AF的患者相比，本研究的结果不确定患者围手术期AF使用是否存在相关性，与未接受围手术期AF治疗的患者相比，使用冠状动脉支架和MACE的结局。作者承认，不精确的置信区间阻碍了明确确定研究人群中是否存在相关性的能力。需要进一步的大型前瞻性研究，以检测MACE的差异，以评估现有冠状动脉支架患者围手术期AF的安全性，并阐明该高危人群围手术期MACE的机制。
Patients with existing coronary artery stents are at increased risk for major adverse cardiac events (MACE) when undergoing noncardiac surgery (NCS). Although the use of antifibrinolytic (AF) therapy in NCS has significantly increased in the past decade, the relationship between perioperative AF use and its association MACE among patients with existing coronary artery stents has yet to be assessed. In this study, we aim to evaluate the association of MACE in patients with existing coronary artery stents who receive perioperative AF therapy during orthopedic surgery. A single-center retrospective cohort study was conducted in adult patients with existing coronary artery stents who underwent orthopedic surgery from 2008–2018. Two cohorts were established: patients with existing coronary artery stents who did not receive perioperative AF and patients with coronary artery stents who received perioperative AF. Associations between AF use and the primary outcome of MACE within 30-days postoperatively and the secondary outcomes of thrombotic complications, excessive surgical bleeding, and ICU admissions were analyzed using logistic regression models. Inverse probability of treatment weighting was used to control for confounding. Secondary analyses examining the association between coronary stent type/timing and the outcomes of interest were performed using unadjusted logistic regression models. 473 patients met study criteria, including 294 who did not receive AF and 179 patients who received AF. MACE occurred in 15 (5.1%) patients who did not receive AF and 1 (0.6%) who received AF (p=0.007). In weighted analyses, no significant difference was found in patients who received AF with regard to MACE (OR 0.13, 95% CI=0.01–1.74, p=0.12), thrombotic complications (OR 1.19, 95% CI=0.53–2.68, p=0.68), or excessive surgical bleeding (OR 0.13, 95% CI=0.01–2.23, p=0.16) compared to patients who did not receive AF. The results of this study are inconclusive whether an association exists between perioperative AF use in patients with coronary artery stents and the outcome of MACE compared to patients who did not receive perioperative AF therapy. The authors acknowledge that the imprecise confidence interval hinders the ability definitively determine whether an association exists in the study population. Further large prospective studies, powered to detect differences in MACE, are needed to assess the safety of perioperative AF in patients with existing coronary artery stents and to clarify the mechanism of perioperative MACE in this high-risk population.