Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery.
Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery.
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与非心脏手术相关的围手术期主要不良心血管和脑血管事件。
DOI：
10.1001/jamacardio.2016.4792
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发表时间：
2017-02-01
期刊：
影响因子：
24
通讯作者：
Bangalore S
中科院分区：
文献类型：
--
作者：
Smilowitz NR;Gupta N;Ramakrishna H;Guo Y;Berger JS;Bangalore S
主要不良心脑血管事件(MACCE)是非心脏手术围手术期发病率和死亡率的重要来源。使用美国大型住院管理数据库，评估主要非心脏手术后围术期心血管结果和死亡率的国家趋势，并确定与心血管事件相关的外科亚型。使用国家住院患者样本确定了2004至2013年间接受重大非心脏手术的患者。围术期MACCE(主要结果)，定义为住院、全因死亡、急性心肌梗死(AMI)或急性缺血性中风，随着时间的推移进行评估。在10,581,621例因主要非心脏手术而住院的患者中，围手术期发生了317,479例(3.0%)，相当于在应用样本权重后的年发病率≈为150,000。主要心血管和脑血管不良事件最常发生在血管(7.7%)、胸部(6.5%)和移植手术(6.3%)患者。在2004年至2013年间，由于围手术期死亡(调整后OR0.79，95%CI0.77-0.81)和急性心肌梗死(调整后OR0.87，95%CI0.84-0.89)发生率下降，但围手术期缺血性卒中发生率从2004年的0.52%增加到2013年的0.77%(趋势<；0.0001；调整后的OR0.95，95%CI0.94-0.97)。调整后的OR 1.79；CI 1.73-1.86)。每33例非心脏手术住院患者中就有1例发生围手术期MACCE。尽管美国接受大型非心脏手术的患者的死亡率和急性心肌梗死的发生率有所下降，但围手术期的缺血性中风随着时间的推移而增加。为改善非心脏手术患者围手术期的心血管护理，有必要做出额外的努力。
Major adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following non-cardiac surgery. To evaluate national trends in perioperative cardiovascular outcomes and mortality after major non-cardiac surgery and identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions. Patients who underwent major non-cardiac surgery from 2004 to 2013 were identified using the National Inpatient Sample. Perioperative MACCE (primary outcome), defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, were evaluated over time. Among 10,581,621 hospitalizations for major non-cardiac surgery, perioperative MACCE occurred in 317,479 (3.0%), corresponding to an annual incidence of ≈150,000 after applying sample weights. Major adverse cardiovascular and cerebrovascular events occurred most frequently in patients undergoing vascular (7.7%), thoracic (6.5%), and transplant surgery (6.3%). Between 2004 and 2013, the frequency of MACCE declined from 3.1% to 2.6% (p for trend <0.0001; adjusted OR 0.95, 95% CI 0.94–0.97) driven by a decline in frequency of perioperative death (adjusted OR 0.79, 95% CI 0.77–0.81) and AMI (adjusted OR 0.87, 95% CI 0.84–0.89) but with an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013 (p for trend <0.0001; adjusted OR 1.79; CI 1.73–1.86). Perioperative MACCE occurs in 1 of every 33 hospitalizations for non-cardiac surgery. Despite reductions in the rate of death and AMI among patients undergoing major non-cardiac surgery in the United States, perioperative ischemic stroke increased over time. Additional efforts are necessary to improve cardiovascular care in the perioperative period of patients undergoing non-cardiac surgery.
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影响因子：
14.6
作者：
Siddiqui, Nausheen F.;Coca, Steven G.;Garg, Amit X.
通讯作者：
Garg, Amit X.
影响因子：
120.7
作者：
Koton, Silvia;Schneider, Andrea L. C.;Coresh, Josef
通讯作者：
Coresh, Josef
骨膜手术后肌活动升高与长期死亡率的关系。
DOI：
10.1016/j.amjcard.2015.03.003
发表时间：
2015-06-15
期刊：
The American journal of cardiology
影响因子：
--
作者：
Oberweis BS;Smilowitz NR;Nukala S;Rosenberg A;Xu J;Stuchin S;Iorio R;Errico T;Radford MJ;Berger JS
通讯作者：
Berger JS
影响因子：
168.9
作者：
Devereaux, P. J.;Yang, Homer;Choi, Peter
通讯作者：
Choi, Peter
影响因子：
39.3
作者：
Berwanger, Otavio;Le Manach, Yannick;Devereaux, P. J.
通讯作者：
Devereaux, P. J.