目标:尽管延长的心率校正QT间期(QTcI)与普通人群的死亡风险增加有关,其在手术患者中的预后价值尚不清楚.我们旨在检查术前QTcI延长是否可预测接受非心脏手术的老年患者的短期术后结局。
方法:本研究采用TriNetX网络数据库进行回顾性分析。
方法:手术室。
方法:术前QTcI的评估和分类。
方法:分析了2010年至2023年接受非心脏手术的年龄≥65岁患者的数据。
方法:根据术前QTcI将患者分为四组:长(500-600ms),边界线(460-500ms),高正常(420-460ms)和控制(370-420ms)组。使用倾向评分匹配分析对两组进行比较。主要结果是全因90天死亡风险。次要结局包括术后新发房颤(Af)的90天风险,室性心律失常(VA),紧急访问,医院再入院,和肺炎。
结果:总计,本研究收集了519,929例患者的数据.配对比较显示,所有QTcI延长组术后死亡率均升高。心律失常,和其他并发症相比对照组。长期QTcI患者的死亡风险高3倍(风险比[HR]=3.124,p<0.001),Af(HR=3.059,p<0.001),和VA(HR=3.617,p<0.001)比对照组。急诊就诊的风险(HR=1.287,p<0.001),医院再入院(HR=1.591,p<0.001),长QTcI组的肺炎(HR=1.672,p<0.001)也高于对照组。QTcI与死亡率和心律失常风险之间存在明显的剂量依赖性反应。
结论:术前QTcI筛查可有效对老年手术患者进行危险分层,QTcI≥500ms是术后短期死亡率和其他并发症的强烈预测因素。将QTcI评估纳入术前评估可以指导围手术期的监测和管理。
OBJECTIVE: Although a prolonged heart rate-corrected QT interval (QTcI) is associated with an increased risk of mortality in the general population, its prognostic value in surgical patients remains unclear. We aimed to examine whether preoperative QTcI prolongation predicts short-term postoperative outcomes in elderly patients undergoing noncardiac surgery.
METHODS: The study was a retrospective analysis using the TriNetX network database.
METHODS: Operating room.
METHODS: Assessment and categorization of preoperative QTcI.
METHODS: Data of patients aged ≥65 years who underwent non-cardiac surgery between 2010 and 2023 were analyzed.
METHODS: Patients were categorized into four groups based on preoperative QTcI: long (500-600 ms), borderline (460-500 ms), high-normal (420-460 ms) and control (370-420 ms) groups. The groups were compared using a propensity score-matched analysis. The primary outcome was the all-cause 90-day mortality risk. The secondary outcomes included 90-day risks of postoperative new-onset atrial fibrillation (Af), ventricular arrhythmias (VAs), emergency visits, hospital readmissions, and pneumonia.
RESULTS: In total, data on 519,929 patients were collected in this study. Pairwise comparisons showed that all QTcI prolongation groups demonstrated a heightened incidence of postoperative mortality, arrhythmias, and other complications compared to the control group. Patients with a long QTcI had a 3-fold higher risk of mortality (hazard ratio [HR] = 3.124, p < 0.001), Af (HR = 3.059, p < 0.001), and VAs (HR = 3.617, p < 0.001) than controls. The risks of emergency visits (HR = 1.287, p < 0.001), hospital readmissions (HR = 1.591, p < 0.001), and pneumonia (HR = 1.672, p < 0.001) were also higher in the long QTcI group than in the control group. A dose-dependent response was evident between QTcI and mortality as well as arrhythmia risk.
CONCLUSIONS: Preoperative QTcI screening effectively risk-stratifies elderly surgical patients, with a QTcI≥500 ms being strongly predictive of short-term postoperative mortality and other complications. Incorporating QTcI assessment into the preoperative evaluation may guide perioperative monitoring and management.