Characteristics and Short- Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery A Cohort Study
Characteristics and Short- Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery A Cohort Study
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DOI：
10.7326/0003-4819-154-8-201104190-00003
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发表时间：
2011-04-19
影响因子：
39.2
通讯作者：
Yusuf, Salim
中科院分区：
文献类型：
--
作者：
Devereaux, P. J.;Xavier, Denis;Yusuf, Salim
背景：每年，全世界有数百万患者在非心脏手术后发生围手术期心肌梗死（MI）。目的：探讨围手术期心肌梗死的特点及近期预后。设计：队列研究。（ClinicalTrials.gov注册号：NCT00182039）设置：23个国家190个中心。患者：8351例患者纳入了POISE（围手术期缺血评估）试验。测量：手术后3天内进行4项心脏生物标志物或酶测定。围手术期心肌梗死的定义包括急性心肌梗死的尸检结果或心脏生物标志物或酶水平升高，以及至少1个以下定义特征：缺血性症状、病理性Q波的发展、心电图缺血性改变、冠状动脉干预或心肌梗死的心脏影像学证据。结果：在随机分配的30天内，415例（5.0%）患者发生围手术期心肌梗死，大多数心肌梗死（74.1%）发生在手术后48小时内；65.3%的患者未出现缺血性症状。围手术期心肌梗死患者的30天死亡率为11.6%（415例患者中有48例），未发生心肌梗死患者的30天死亡率为2.2%（7936例患者中有178例）（P < 0.001）。在围手术期心肌梗死患者中，有（9.7%，校正优势比为4.76 [95% CI， 2.68至8.43]）和无（12.5%，校正优势比为4.00 [CI， 2.65至6.06]）缺血性症状的患者死亡率升高且相似。局限性：仅在手术后第3天测量心脏标志物，可能遗漏了其他无症状的心肌梗死。结论：大多数围手术期心肌梗死患者不会出现缺血性症状。数据表明，手术后需要对高危患者的肌钙蛋白水平进行常规监测，以发现大多数MIs，无论其是否有症状，预后都同样差。
Background: Each year, millions of patients worldwide have a perioperative myocardial infarction (MI) after noncardiac surgery.Objective: To examine the characteristics and short-term outcome of perioperative MI.Design: Cohort study. (ClinicalTrials.gov registration number: NCT00182039)Setting: 190 centers in 23 countries.Patients: 8351 patients included in the POISE (PeriOperative ISchemic Evaluation) trial.Measurements: Four cardiac biomarker or enzyme assays were measured within 3 days of surgery. The definition of perioperative MI included either autopsy findings of acute MI or an elevated level of a cardiac biomarker or enzyme and at least 1 of the following defining features: ischemic symptoms, development of pathologic Q waves, ischemic changes on electrocardiography, coronary artery intervention, or cardiac imaging evidence of MI.Results: Within 30 days of random assignment, 415 patients (5.0%) had a perioperative MI. Most MIs (74.1%) occurred within 48 hours of surgery; 65.3% of patients did not experience ischemic symptoms. The 30-day mortality rate was 11.6% (48 of 415 patients) among patients who had a perioperative MI and 2.2% (178 of 7936 patients) among those who did not (P < 0.001). Among patients with a perioperative MI, mortality rates were elevated and similar between those with (9.7%; adjusted odds ratio, 4.76 [95% CI, 2.68 to 8.43]) and without (12.5%; adjusted odds ratio, 4.00 [CI, 2.65 to 6.06]) ischemic symptoms.Limitation: Cardiac markers were measured only until day 3 after surgery, and additional asymptomatic MIs may have been missed.Conclusion: Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.