PDF(Pubmed)
Abstract：
BACKGROUND: Perioperative myocardial injury/infarction (PMI) following noncardiac surgery is a frequent cardiac complication. This study aims to evaluate PMI risk and explore preoperative assessment tools of PMI in patients at increased cardiovascular (CV) risk who underwent noncardiac surgery under the surgical and medical co-management (SMC) model.
METHODS: A prospective cohort study that included consecutive patients at increased CV risk who underwent intermediate- or high-risk noncardiac surgery at the Second Medical Center, Chinese PLA General Hospital, between January 2017 and December 2022. All patients were treated with perioperative management by the SMC team. The SMC model was initiated when surgical intervention was indicated and throughout the entire perioperative period. The incidence, risk factors, and impact of PMI on 30-day mortality were analyzed. The ability of the Revised Cardiac Risk Index (RCRI), frailty, and their combination to predict PMI was evaluated.
RESULTS: 613 eligible patients (mean [standard deviation, SD] age 73.3[10.9] years, 94.6% male) were recruited consecutively. Under SMC, PMI occurred in 24/613 patients (3.9%). Patients with PMI had a higher rate of 30-day mortality than patients without PMI (29.2% vs. 0.7%, p = 0.00). The FRAIL Scale for frailty was independently associated with an increased risk for PMI (odds ratio = 5.91; 95% confidence interval [CI], 2.34-14.93; p = 0.00). The RCRI demonstrated adequate discriminatory capacity for predicting PMI (area under the curve [AUC], 0.78; 95% CI, 0.67-0.88). Combining frailty with the RCRI further increased the accuracy of predicting PMI (AUC, 0.87; 95% CI, 0.81-0.93).
CONCLUSIONS: The incidence of PMI was relatively low in high CV risk patients undergoing intermediate- or high-risk noncardiac surgery under SMC. The RCRI adequately predicted PMI. Combining frailty with the RCRI further increased the accuracy of PMI predictions, achieving excellent discriminatory capacity. These findings may aid personalized evaluation and management of high-risk patients who undergo intermediate- or high-risk noncardiac surgery.
METHODS: A prospective cohort study that included consecutive patients at increased CV risk who underwent intermediate- or high-risk noncardiac surgery at the Second Medical Center, Chinese PLA General Hospital, between January 2017 and December 2022. All patients were treated with perioperative management by the SMC team. The SMC model was initiated when surgical intervention was indicated and throughout the entire perioperative period. The incidence, risk factors, and impact of PMI on 30-day mortality were analyzed. The ability of the Revised Cardiac Risk Index (RCRI), frailty, and their combination to predict PMI was evaluated.
RESULTS: 613 eligible patients (mean [standard deviation, SD] age 73.3[10.9] years, 94.6% male) were recruited consecutively. Under SMC, PMI occurred in 24/613 patients (3.9%). Patients with PMI had a higher rate of 30-day mortality than patients without PMI (29.2% vs. 0.7%, p = 0.00). The FRAIL Scale for frailty was independently associated with an increased risk for PMI (odds ratio = 5.91; 95% confidence interval [CI], 2.34-14.93; p = 0.00). The RCRI demonstrated adequate discriminatory capacity for predicting PMI (area under the curve [AUC], 0.78; 95% CI, 0.67-0.88). Combining frailty with the RCRI further increased the accuracy of predicting PMI (AUC, 0.87; 95% CI, 0.81-0.93).
CONCLUSIONS: The incidence of PMI was relatively low in high CV risk patients undergoing intermediate- or high-risk noncardiac surgery under SMC. The RCRI adequately predicted PMI. Combining frailty with the RCRI further increased the accuracy of PMI predictions, achieving excellent discriminatory capacity. These findings may aid personalized evaluation and management of high-risk patients who undergo intermediate- or high-risk noncardiac surgery.
摘要：
背景：非心脏手术后的围手术期心肌损伤/梗塞（PMI）是常见的心脏并发症。本研究旨在评估PMI风险，并探索在手术和医疗共同管理（SMC）模型下接受非心脏手术的心血管（CV）风险增加的患者的PMI术前评估工具。
方法：一项前瞻性队列研究，包括在第二医疗中心接受中高风险非心脏手术的心血管风险增加的连续患者，中国人民解放军总医院,2017年1月至2022年12月。所有患者均接受SMC团队的围手术期处理。SMC模型是在需要手术干预时启动的，贯穿整个围手术期。发病率，危险因素，并分析了PMI对30天死亡率的影响。修订后的心脏风险指数（RCRI）的能力，脆弱,并对它们的组合预测PMI进行了评估。
结果：613名合格患者（平均值[标准差，SD]年龄73.3[10.9]岁，94.6%男性）连续招募。在SMC下,PMI发生在24/613患者中(3.9%)。PMI患者30天死亡率高于无PMI患者（29.2%vs.0.7%，p=0.00)。虚弱的FRAIL量表与PMI风险增加独立相关(比值比=5.91;95%置信区间[CI],2.34-14.93；p=0.00）。RCRI显示出足够的判别能力来预测PMI(曲线下面积[AUC]，0.78；95%CI，0.67-0.88）。将脆弱与RCRI相结合，进一步提高了预测PMI(AUC，0.87；95%CI，0.81-0.93）。
结论：在SMC下接受中高风险非心脏手术的高CV风险患者中，PMI的发生率相对较低。RCRI充分预测了PMI。将脆弱与RCRI相结合，进一步提高了PMI预测的准确性，实现优秀的歧视能力。这些发现可能有助于对接受中危或高危非心脏手术的高危患者进行个性化评估和管理。
方法：一项前瞻性队列研究，包括在第二医疗中心接受中高风险非心脏手术的心血管风险增加的连续患者，中国人民解放军总医院,2017年1月至2022年12月。所有患者均接受SMC团队的围手术期处理。SMC模型是在需要手术干预时启动的，贯穿整个围手术期。发病率，危险因素，并分析了PMI对30天死亡率的影响。修订后的心脏风险指数（RCRI）的能力，脆弱,并对它们的组合预测PMI进行了评估。
结果：613名合格患者（平均值[标准差，SD]年龄73.3[10.9]岁，94.6%男性）连续招募。在SMC下,PMI发生在24/613患者中(3.9%)。PMI患者30天死亡率高于无PMI患者（29.2%vs.0.7%，p=0.00)。虚弱的FRAIL量表与PMI风险增加独立相关(比值比=5.91;95%置信区间[CI],2.34-14.93；p=0.00）。RCRI显示出足够的判别能力来预测PMI(曲线下面积[AUC]，0.78；95%CI，0.67-0.88）。将脆弱与RCRI相结合，进一步提高了预测PMI(AUC，0.87；95%CI，0.81-0.93）。
结论：在SMC下接受中高风险非心脏手术的高CV风险患者中，PMI的发生率相对较低。RCRI充分预测了PMI。将脆弱与RCRI相结合，进一步提高了PMI预测的准确性，实现优秀的歧视能力。这些发现可能有助于对接受中危或高危非心脏手术的高危患者进行个性化评估和管理。
