手术前心脏应力测试的后果 - 一个队列研究
Matthew A Pappas1, Andrew D Auerbach2, Michael W Kattan3
1Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, United States of America; Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, United States of America; Outcomes Research Consortium, Cleveland, OH, United States of America.
手术前的心脏应力测试增加了心脏手术和延迟非心脏手术,但不会对患者死亡率产生因果影响. 这一发现对于理解手术前心脏检测的含义至关重要.
科学领域:
- 心脏病学 心脏病学
- 在外科手术期间的医学.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 手术前的心脏应力测试是接受非心脏手术的患者的常见做法.
- 了解这种测试对手术决策和患者结果的下游影响和实际影响至关重要.
研究的目的:
- 评估非心脏,非眼科手术预定的患者功能性心脏应力测试的后果.
- 分析压力测试如何影响后续的医疗干预和手术时间表.
主要方法:
- 从2008年至2018年,对118,552名患者进行了回顾性队列研究.
- 分析了手术前风险评估和优化诊所的数据.
- 测量心脏检测,心脏手术和非心脏手术率的变化,以及死亡率的结果.
主要成果:
- 压力测试增加了冠状动脉血管学和心脏干预的可能性.
- 它降低了非心脏手术的可能性,并延迟了其执行.
- 在因果推断模型中,压力测试和术后死亡率之间没有发现因果关系.
结论:
- 手术前的心脏应力测试通过增加心脏干预和延迟非心脏手术来改变护理途径.
- 该研究没有发现压力测试直接导致术后死亡的证据.
- 护理级联分析应考虑诱导和避免/替代护理.
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