Relationship between Perioperative Hypotension and Perioperative Cardiovascular Events in Patients with Coronary Artery Disease Undergoing Major Noncardiac Surgery
Relationship between Perioperative Hypotension and Perioperative Cardiovascular Events in Patients with Coronary Artery Disease Undergoing Major Noncardiac Surgery
复制标题
DOI：
10.1097/aln.0000000000002654
复制
发表时间：
2019-05-01
期刊：
影响因子：
8.8
通讯作者：
Devereaux, P. J.
中科院分区：
文献类型：
--
作者：
Roshanov, Pavel S.;Sheth, Tej;Devereaux, P. J.
背景：非心脏手术患者围手术期低血压与心血管事件相关。目前尚不清楚是否先前存在的冠状动脉疾病的严重程度决定了对围手术期低血压心血管风险的易感性。方法：对一项国际前瞻性盲法队列研究的一项亚研究进行回顾性探索性分析，955名年龄≥45岁、有冠状动脉疾病病史或有危险因素的患者在择期住院非心脏手术前接受了冠状动脉计算机断层血管造影。作者评估了血管造影结果与围手术期低血压（定义为手术期间收缩压小于90 mmHg，持续时间≥10分钟或更长，或手术后任何持续时间，并开始干预）对术后30天内心肌梗死或心血管死亡的综合结果的潜在相互作用。血管造影评估者对研究结果采取盲法；患者、治疗临床医生和结果评估者对血管造影结果不知情。结果：7.7%的患者（74/955）发生心血管事件（心肌梗死或术后30天内心血管死亡），其中无梗阻性冠状动脉疾病或低血压的患者（2.7%(8/293)）与无梗阻性冠状动脉疾病但无低血压的患者（6.7%(21/314)）（风险比为2.51,95% CI为1.11 ~ 5.66,P = 0.027），有低血压但无梗阻性冠状动脉疾病的患者(风险比为3.85,95% CI为1.62 ~ 9.19；P = 0.002), 16.4%（31/189）伴有阻塞性冠状动脉疾病和低血压（风险比7.34;95% CI, 3.37 ~ 15.96; P < 0.001）。低血压与心血管事件独立相关（风险比3.17;95% CI 1.99 ~ 5.06; P < 0.001）。这种相关性在无阻塞性疾病的患者中仍然存在，并且在冠状动脉疾病的不同程度上没有显著差异（相互作用的P值为0.599）。结论：在非心脏手术患者中，围手术期低血压与心血管事件相关，与术前冠状动脉ct血管造影显示的冠状动脉疾病程度无关。
Background: Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery. It is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension.Methods: In this retrospective exploratory analysis of a substudy of an international prospective blinded cohort study, 955 patients 45 yr of age or older with history or risk factors for coronary artery disease underwent coronary computed tomographic angiography before elective inpatient noncardiac surgery. The authors evaluated the potential interaction between angiographic findings and perioperative hypotension (defined as systolic blood pressure less than 90 mmHg for a total of 10 min or more during surgery or for any duration after surgery and for which intervention was initiated) on the composite outcome of time to myocardial infarction or cardiovascular death up to 30 days after surgery. Angiography assessors were blinded to study outcomes; patients, treating clinicians, and outcome assessors were blinded to angiography findings.Results: Cardiovascular events (myocardial infarction or cardiovascular death within 30 days after surgery) occurred in 7.7% of patients (74/955), including in 2.7% (8/293) without obstructive coronary disease or hypotension compared to 6.7% (21/314) with obstructive coronary disease but no hypotension (hazard ratio, 2.51; 95% CI, 1.11 to 5.66; P = 0.027), 8.8% (14/159) in patients with hypotension but without obstructive coronary disease (hazard ratio, 3.85; 95% CI, 1.62 to 9.19; P = 0.002), and 16.4% (31/189) with obstructive coronary disease and hypotension (hazard ratio, 7.34; 95% CI, 3.37 to 15.96; P < 0.001). Hypotension was independently associated with cardiovascular events (hazard ratio, 3.17; 95% CI, 1.99 to 5.06; P < 0.001). This association remained in patients without obstructive disease and did not differ significantly across degrees of coronary disease (P value for interaction, 0.599).Conclusions: In patients having noncardiac surgery, perioperative hypotension was associated with cardiovascular events regardless of the degree of coronary artery disease on preoperative coronary computed tomographic angiography.