在皮肤冠状动脉干预2年内进行的非心脏手术后的结果
Neel M Butala1,2, Annika Hebbe3, Binita Shah4,5
1University of Colorado School of Medicine Aurora CO USA.
Journal of the American Heart Association
|March 13, 2025
概括
经过皮肤冠状动脉干预 (PCI) 进行非心脏手术的患者有类似的重大心血管不良事件 (MACE),但死亡风险较低. 一个新的风险模型有助于预测这些患者的结果.
科学领域:
- 心脏病学 心脏病学
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
背景情况:
- 有限的当代数据存在于之前皮肤冠状动脉干预 (PCI) 的非心脏手术患者.
- 了解PCI后2年内接受非心脏手术的患者的结果至关重要.
- 需要开发一个预测性风险模型来预测长期的术后结果.
研究的目的:
- 检查PCI后2年内接受非心脏手术的患者的发病率,特征和结果.
- 为了比较最近的PCI和没有PCI的患者的主要不良心血管事件 (MACE).
- 开发和验证一种风险模型,用于预测近期PCI患者的1年术后MACE.
主要方法:
- 使用了退伍军人事务外科质量改善计划数据库 (2017年10月至2021年9月).
- 倾向性与在2年内接受非心脏手术的PCI和没有PCI的患者相匹配.
- 定义MACE为1年的死亡率,再血管化和心肌梗塞或中风再住院的复合值.
- 开发了一个13个组件的风险模型,使用多变量逻辑回归来预测MACE.
主要成果:
- 在334,028名手术患者中,0.68%的患者在2年内进行PCI.
- 最近的PCI和没有PCI的倾向匹配患者之间的1年MACE没有显著差异 (HR,1.04).
- 最近进行PCI的患者在1年内全因死亡率 (HR,0.83) 较低,但重血管化风险 (HR,1.88) 较高.
- 该MACE预测模型显示了中度的歧视 (AUC0.73导出,0.72验证).
结论:
- 在最近接受非心脏手术的PCI和没有PCI的患者之间,MACE的总体风险没有差异.
- 最近接受过PCI的患者有更高的复血管化风险和较低的全因死亡风险.
- 一个经过验证的风险模型可以有效地分层手术风险在之前的PCI患者中.
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