Reducing cardiac risk in non-cardiac surgery: evidence from the DECREASE studies
Reducing cardiac risk in non-cardiac surgery: evidence from the DECREASE studies
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DOI：
10.1093/eurheartj/sup004
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发表时间：
2009-03-01
影响因子：
1.6
通讯作者：
Winkel, Tamara A.
中科院分区：
文献类型：
--
作者：
Poldermans, Don;Schouten, Olaf;Winkel, Tamara A.
缺血性心脏事件是非心脏手术围手术期发病率和死亡率的主要原因； 10-40% 的围手术期死亡是由于心肌梗塞 (MI)。影响心肌氧平衡的药物（例如β受体阻滞剂）或改善斑块稳定性的药物（例如他汀类药物）有望减少围手术期心肌梗死。 β受体阻滞剂对接受非心脏手术的高危患者有益的证据来自各种研究，包括荷兰超声心动图心脏风险评估应用负荷超声心动图（DECREASE）研究，其中围手术期比索洛尔显着减少短期和长期心源性死亡和心肌梗死。 DECREASE IV 发现，比索洛尔还显着降低了中等风险患者的 30 天心源性死亡和 MI，而氟伐他汀 XL 的有益效果没有显着趋势。 DECREASE III 表明，在接受大血管手术的高危患者中，氟伐他汀 XL 可减少心肌缺血以及心血管死亡和 MI 的综合终点。 DECREASE II 表明，根据临床评估确定为中等风险的患者不需要术前超声心动图心脏负荷测试，只要他们接受比索洛尔以保持严格的心率控制即可。 DECREASE V 发现，在患有广泛应激性缺血的高危患者中，冠状动脉血运重建（加上比索洛尔严格的心率控制）并没有进一步减少死亡和心肌梗死。
Ischaemic cardiac events are a major cause of perioperative morbidity and mortality in non-cardiac surgery; 10-40% of the perioperative deaths are due to myocardial infarction (MI). Drugs that influence myocardial oxygen balance (e.g. beta-blockers) or improve plaque stability (e.g. statins) would be expected to reduce perioperative MI. Evidence for the benefit of beta-blockers in high-risk patients undergoing noncardiac surgery comes from various studies including the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) study, in which perioperative bisoprolol significantly reduced short- and long-term cardiac death and MI. DECREASE IV found that bisoprolol also significantly reduced 30-day cardiac death and MI in intermediate-risk patients, with a non-significant trend towards a beneficial effect of fluvastatin XL. DECREASE III showed that in high-risk patients undergoing major vascular surgery, fluvastatin XL reduced myocardial ischaemia and the combined endpoint of cardiovascular death and MI. DECREASE II showed that patients identified as intermediate risk on the basis of clinical assessment did not need pre-operative echocardiographic cardiac stress testing, provided that they received bisoprolol to maintain tight heart rate control. DECREASE V found that in high-risk patients with extensive stress-induced ischaemia, coronary revascularization (added to tight heart rate control with bisoprolol) did not produce any additional reduction in death and MI.