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首页> 外文期刊>The American Journal of Cardiology >Effect of Preoperative Angina Pectoris on Cardiac Outcomes in Patients With Previous Myocardial Infarction Undergoing Major Noncardiac Surgery (Data from ACS-NSQIP)
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Effect of Preoperative Angina Pectoris on Cardiac Outcomes in Patients With Previous Myocardial Infarction Undergoing Major Noncardiac Surgery (Data from ACS-NSQIP)

机译：术前心绞痛对接受非心脏大手术的既往心肌梗死患者心脏结局的影响（数据来自ACS-NSQIP）

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摘要

The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35% women) with previous MI who underwent major noncardiac surgery, 5.5% had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4% vs 5%, p = 0.035). In secondary outcomes, reintervention rates (22.5% vs 11%, p < 0.001) and length of stay (median 6-days vs 5-days; p < 0.001) were also higher in patients with preoperative angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication. (C) 2015 Elsevier Inc. All rights reserved.
机译：术前稳定型心绞痛对接受过大型非心脏手术的既往心肌梗死（MI）患者术后心血管结局的影响尚未得到很好的研究。我们在美国外科医生学会国家外科手术质量改善计划（2005年至2011年）中研究了曾接受择期重大非心脏手术的先前MI患者。主要结果是发生不良心脏事件（心梗和/或心脏骤停）。多变量逻辑回归模型评估稳定型心绞痛对预后的影响。在1,568名接受过重大非心脏手术的先前MI患者中（中位年龄70岁; 35％女性），其中5.5％的患者术后MI和/或心脏骤停。与无心绞痛症状的患者相比，有术前心绞痛病史的患者的主要结局发生率显着更高（8.4％vs 5％，p = 0.035）。在次要结局方面，术前心绞痛患者的再干预率（22.5％vs 11％，p <0.001）和住院时间（中位6天vs 5天; p <0.001）也更高。在多变量分析中，术前心绞痛是术后心肌梗塞（比值比2.49 [1.20至5.58]）和再干预（比值比值2.40 [1.44至3.82]）的重要预测指标。总之，我们的研究表明，术前心绞痛是接受过大型非心脏手术的先前MI患者不良后果的独立预测因子，并告诫这些患者不要过度依赖预测工具，例如修订的心脏风险指数，在风险预后期间不要将稳定型心绞痛和先前的心梗视为独立的危险因素。 （C）2015 Elsevier Inc.保留所有权利。

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