JAHA:非心脏手术后心肌损伤与长期死亡风险增加相关

2021-06-20 MedSci原创 MedSci原创

目前的术前危险分层工具不能预测术后1年肌钙蛋白升高和全因死亡率的风险。有趣的是,与一般人群相比,术前被归类为低风险的MINS患者1年死亡率风险显著升高,而且他们中的大多数没有服用他汀类药物。

先前的研究表明,非心脏手术后心肌损伤 (MINS) 与非心脏手术后患者的全因死亡率之间存在关联。然而,术前风险评估、修订的心脏风险指数和美国外科医师学会国家手术质量改进计划与术后肌钙蛋白升高和长期死亡率之间的关联尚未明确。

近日,血管疾病领域权威杂志JAHA上发表了一篇研究文章,这项回顾性图表审查明确了548名住院的非心脏手术患者术后14天内肌钙蛋白I的水平。该研究纳入了年龄在40至80岁且至少有2项心血管危险因素的患者,而有外伤、肺栓塞和神经外科手术的患者被排除在外。

研究人员使用Kaplan-Meier生存率和比值比 (OR) 进行敏感性/特异性分析,以评估术前风险与术后肌钙蛋白升高与1年全因死亡率之间的关联。

Kaplan-Meier生存曲线

总体而言,根据修订的心脏风险指数,69%/31%的患者被归类为低风险/高风险,根据美国外科医师学会国家外科质量改进计划,66%/34%的患者被归类为低风险/高风险患者。研究人员比较了低风险组与高风险组,术前风险评估与术后肌钙蛋白升高或1年死亡率无关。MINS预示总人群的1年死亡率OR为3.9(95%CI为2.44-6.33)。术前采用MINS归类为低风险的患者1年死亡率的风险最高(OR为9.6;95%CI为4.27-24.38),而他汀类药物的使用率较低。

由此可见,目前的术前危险分层工具不能预测术后1年肌钙蛋白升高和全因死亡率的风险。有趣的是,与一般人群相比,术前被归类为低风险的MINS患者1年死亡率风险显著升高,而且他们中的大多数没有服用他汀类药物

原始出处:

Sunil K. Vasireddi.et al.Postoperative Myocardial Injury in Patients Classified as Low Risk Preoperatively Is Associated With a Particularly Increased Risk of Long‐Term Mortality After Noncardiac Surgery.J AM HEART ASSOC.2021.https://www.ahajournals.org/doi/full/10.1161/JAHA.120.019379

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  4. [GetPortalCommentsPageByObjectIdResponse(id=1819306, encodeId=f6441819306f4, content=<a href='/topic/show?id=aba89940943' target=_blank style='color:#2F92EE;'>#非心脏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99409, encryptionId=aba89940943, topicName=非心脏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Wed Oct 27 02:31:57 CST 2021, time=2021-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819385, encodeId=e3a618193855f, content=<a href='/topic/show?id=210c9941411' target=_blank style='color:#2F92EE;'>#非心脏手术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99414, encryptionId=210c9941411, topicName=非心脏手术后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Sat Aug 14 14:31:57 CST 2021, time=2021-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256091, encodeId=686912560913b, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Tue Jun 22 03:31:57 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268561, encodeId=3e82126856112, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Tue Jun 22 03:31:57 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310091, encodeId=f2691310091fb, content=<a href='/topic/show?id=ddd95126e4e' target=_blank style='color:#2F92EE;'>#心肌损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51267, encryptionId=ddd95126e4e, topicName=心肌损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4723380, createdName=yangcx0915, createdTime=Tue Jun 22 03:31:57 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1398149, encodeId=c1fe1398149d0, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Tue Jun 22 03:31:57 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488305, encodeId=fe491488305c2, content=<a href='/topic/show?id=f37799413a6' target=_blank style='color:#2F92EE;'>#非心脏手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99413, encryptionId=f37799413a6, topicName=非心脏手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b5438409695, createdName=bnurmamat, createdTime=Tue Jun 22 03:31:57 CST 2021, time=2021-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975247, encodeId=5be69e52473e, content=好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210412/ed7fbddfbc0d4a75affee17ba0f2528c/7a517c94ffa54cf99af33647f3fe9aa5.jpg, createdBy=528b5420040, createdName=SunshineR吖呀, createdTime=Sun Jun 20 22:09:22 CST 2021, time=2021-06-20, status=1, ipAttribution=)]
    2021-06-22 zhaohui6731
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    2021-06-20 SunshineR吖呀

    好。

    0

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