STudy of Risk Assessment To reduce complications In patients Following noncardiac surgerY (STRATIFY)

心脏问题是接受重大非心脏手术的患者的许多并发症的原因，即使是明显的轻微心脏损伤也是随后不良事件的高风险标志。不幸的是，虽然金钱和精力都花在识别风险患者上，但对这种风险的适当反应还很不清楚。为治疗高危患者的潜在冠状动脉疾病而进行的搭桥手术或球囊血管成形术用于其他情况，并降低长期风险。然而，在许多接受重大非心脏手术的患者中，这种方法可能是不适当的侵略性的，因为这些患者通常是老年人，患有其他疾病，使心脏手术比平常更困难和危险，并且在任何情况下都可能因需要手术的疾病而缩短预期寿命。由于最关键的问题是确保患者顺利接受手术，另一种选择是使用强化药物治疗来保护心脏。这项多中心研究以进行大量大手术的布里斯班医院为基础，将对患者的并发症进行随访，并将在手术后6个月评估结果（包括生活质量）。我们将讨论两个重要的问题，即降低风险战略的有效性和成本。首先，对于高风险和压力测试阳性的患者，旨在保护心脏的药物治疗组合是否与当前方法（包括搭桥手术或冠状动脉球囊成形术）一样有效？第二，在被确定为有一定风险但风险较低的患者中，药物是否足够有效，以避免需要进一步测试来量化风险？随着人口的不断老龄化，接受大手术的风险患者数量将增加，这些问题的答案将提供重要的信息来指导他们的管理。

Cardiac problems account for many complications in patients undergoing major non-cardiac surgery, and even apparently minor cardiac damage is a marker of high risk for subsequent adverse events. Unfortunately, while money and effort is expended on identifying patients at risk, the appropriate response to this risk is quite unclear. The performance of bypass surgery or balloon angioplasty in order to treat the underlying coronary disease of at-risk patients is used in other situations, and reduces longterm risk. However, in many patients undergoing major noncardiac surgery, this approach may be inappropriately aggressive, as these patients are often elderly, have other diseases that make heart operations more difficult and risky than usual, and in any case may have a reduced life expectancy from the disease necessitating the operation. As the most critical issue is to ensure that patients undergo their surgery uneventfully, an alternative is the use of intensive medical therapy to protect the heart. This multicentre study, based at Brisbane hospitals that perform large numbers of major operations, will follow up patients for complications, and outcome (including quality of life) will be assessed six months after the operation. We will address two important questions about the efficacy and cost of risk reduction strategies. First, in patients at higher levels of risk and with a positive stress test, could a combination of medical therapy designed to protect the heart be as effective as current approaches, which include the performance of bypass surgery or coronary balloon angioplasty? Second, in patients identified as being at some risk - but low risk - are drugs sufficiently effective to avoid the need for further testing to quantify risk? As the population continues to age, the numbers of at risk patients undergoing major surgery will increase, and answers to these questions will provide important information to guide their management.