术前心内科会诊对非心脏手术患者主要不良心脏事件的影响:一项回顾性队列研究OA
Impact of preoperative cardiology consultation on major adverse cardiac events in non-cardiac surgery patients:a retrospective cohort study
目的 探讨术前心内科会诊是否可以降低非心脏手术患者主要不良心脏事件(MACE)的发生率.方法 研究共纳入7019例65岁及以上非心脏手术患者,患者均存在心电图(ECG)异常.主要结局指标为术后30 d内MACE的发生率.按7∶3比例将人群分为开发队列和验证队列,并根据ECG异常风险分为高危组和低危组.各亚组建立了MACE预测模型,采用受试者工作特征曲线(ROC曲线)分析其预测效能,并通过决策曲线分析(DCA)评估术前心内科会诊的价值.结果 开发队列共有4914例患者,3010例为低风险的异常心电图,其中61例发生MACE(2.0%),1904例为高风险的异常心电图,其中59例发生MACE(3.1%).在MACE的预测模型中,低风险组包含6个危险因素(AUC=0.772),而高风险组包含5个危险因素(AUC=0.769).对于低风险的异常心电图患者,接受心内科会诊并未显示出显著的益处(预测发生主要不良心脏事件的风险阈值为0.02).高风险异常心电图组和合并某些危险因素的低风险异常心电图组中,接受心内科会诊显示出显著的获益(预测发生主要不良心脏事件的风险阈值分别为0.3和0.229).结论 高危异常ECG和有特定危险因素的低危异常ECG患者行心内科会诊可降低术后MACE发生率;而单纯低危异常ECG患者术前心内科会诊并未见明显获益,且未改善MACE的发生率.
Objective To investigate whether preoperative cardiology consultation reduces the incidence of major adverse cardiac events(MACE)in patients undergoing non-cardiac surgeries.Methods This cohort study was conducted among 7019 elderly patients(above 65 years)with abnormal ECGs undergoing non-cardiac surgeries.The main outcome was MACE occurrence within 30 days post-surgery.The patients were divided into model development and validation cohorts in a 7:3 ratio,and each cohort was categorized into two subgroups with high-risk and low-risk abnormal ECG.MACE prediction models were constructed for the subgroups,and their predictive power was evaluated using ROC curves;the value of preoperative cardiology consultation for reducing MACE was assessed using decision curve analysis.Results Among the 4914 patients in the model development cohort,61 of the 3010 patients with low-risk abnormal ECGs experienced MACE(2.0%),as compared with 59 out of 1904 patients(3.1%)in the high-risk group.The predictive model for MACE for the low-risk group contained 6 risk factors(AUC=0.772),and that for the high-risk group contained 5 risk factors(AUC=0.769).In patients with low-risk abnormal ECG,undergoing cardiovascular specialist consultation did not show significant benefits(the survival rate for predicting MACE was 0.02).However,in patients with high-risk abnormal ECG and those with low-risk abnormal ECG but having specific risk factors,undergoing cardiovascular specialist consultation showed significant benefits with survival rates for predicting MACE of 0.3 and 0.229,respectively.Conclusion For patients with high-risk abnormal ECG and those with low-risk abnormal ECG and specific risk factors,preoperative cardiology consultation may help to reduce the occurrence of MACE following non-cardiac surgeries,but for patients with simple low-risk abnormal ECG cases without risk factors,preoperative cardiology consultation can be omitted,which does not affect the incidence of MACE but can improve medical efficiency.
王沛齐;张凯;王海军;杨路加;刘艳红;曹江北;李皓;米卫东;娄景盛
解放军总医院 第一医学中心麻醉科,北京,100853解放军总医院 第一医学中心麻醉科,北京,100853解放军总医院 第二医学中心 心血管科,北京,100853解放军总医院 第一医学中心麻醉科,北京,100853解放军总医院 第一医学中心麻醉科,北京,100853解放军总医院 第一医学中心麻醉科,北京,100853解放军总医院 第一医学中心麻醉科,北京,100853解放军总医院 第一医学中心麻醉科,北京,100853解放军总医院 第一医学中心麻醉科,北京,100853
异常心电图术前心内科会诊主要不良心脏事件老年患者
abnormal electrocardiogrampreoperative cardiology consultationmajor adverse cardiac eventselderly patients
《南方医科大学学报》 2026 (6)
1301-1312,12
国家重点研发计划(2018YFC2001900) Supported by the National Key Research and Development Program of China(2018YFC2001900).
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