Morbidity and Mortality After Acute Myocardial Infarction After Elective Major Noncardiac Surgery
Copyright © 2020 Elsevier Inc. All rights reserved..
OBJECTIVES: To develop parsimonious models of in-hospital mortality and morbidity risk after perioperative acute myocardial infarction (AMI).
DESIGN: Retrospective data analysis.
SETTING: National Inpatient Sample (2008-2013), a 20% sample of all non-federal in-patient hospitalizations in the United States.
PARTICIPANTS: Patients 45 years or older who experienced perioperative AMI during elective admission for noncardiac surgery.
INTERVENTIONS: The study used a mixed principal components analysis and multivariate logistic regression to identify risk factors for in-hospital mortality after perioperative AMI. A model incorporating only preoperative risk factors, defined by the Revised Cardiac Risk Index (RCRI), was compared with a "full risk factor" model, incorporating a large set of preoperative AMI risk factors. The risk of post-AMI disposition to an intermediate care or skilled nursing facility, a marker of functional impairment, then was evaluated.
MEASUREMENTS AND MAIN RESULTS: In the present study, 15,574 cases of AMI after elective noncardiac surgery were identified (0.42%, corresponding with 78,122 cases nationally), with a 12.4% in-hospital mortality rate. The "RCRI-only" model was the best-fit model of post-AMI in-hospital mortality risk, without loss of predictive accuracy compared with the "full risk factor" model (area under the receiver operator characteristic curve 0.80, 95% confidence interval [CI] [0.77-0.82] v area under the receiver operator characteristic curve 0.81, 95% CI [0.77-0.83], respectively). Post-AMI mortality risk was the highest for perioperative complications, including sepsis (odds ratio 4.95, 95% CI [4.32-5.67]). Conversely, functional impairment was best predicted by the "full-risk factor" model and depended strongly on chronic preoperative comorbidities.
CONCLUSIONS: The RCRI provides a simple but adequate model of preoperative risk factors for in-hospital mortality after perioperative AMI.
| Errataetall: |
CommentIn: J Cardiothorac Vasc Anesth. 2021 Mar;35(3):843-845. - PMID 33342739 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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| Enthalten in: |
Journal of cardiothoracic and vascular anesthesia - 35(2021), 3 vom: 24. März, Seite 834-842 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ranjeva, Sylvia L [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 19.05.2021 Date Revised 02.03.2022 published: Print-Electronic CommentIn: J Cardiothorac Vasc Anesth. 2021 Mar;35(3):843-845. - PMID 33342739 Citation Status MEDLINE |
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| doi: |
10.1053/j.jvca.2020.10.016 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a CommentIn: J Cardiothorac Vasc Anesth. 2021 Mar;35(3):843-845. - PMID 33342739 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: To develop parsimonious models of in-hospital mortality and morbidity risk after perioperative acute myocardial infarction (AMI) | ||
| 520 | |a DESIGN: Retrospective data analysis | ||
| 520 | |a SETTING: National Inpatient Sample (2008-2013), a 20% sample of all non-federal in-patient hospitalizations in the United States | ||
| 520 | |a PARTICIPANTS: Patients 45 years or older who experienced perioperative AMI during elective admission for noncardiac surgery | ||
| 520 | |a INTERVENTIONS: The study used a mixed principal components analysis and multivariate logistic regression to identify risk factors for in-hospital mortality after perioperative AMI. A model incorporating only preoperative risk factors, defined by the Revised Cardiac Risk Index (RCRI), was compared with a "full risk factor" model, incorporating a large set of preoperative AMI risk factors. The risk of post-AMI disposition to an intermediate care or skilled nursing facility, a marker of functional impairment, then was evaluated | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: In the present study, 15,574 cases of AMI after elective noncardiac surgery were identified (0.42%, corresponding with 78,122 cases nationally), with a 12.4% in-hospital mortality rate. The "RCRI-only" model was the best-fit model of post-AMI in-hospital mortality risk, without loss of predictive accuracy compared with the "full risk factor" model (area under the receiver operator characteristic curve 0.80, 95% confidence interval [CI] [0.77-0.82] v area under the receiver operator characteristic curve 0.81, 95% CI [0.77-0.83], respectively). Post-AMI mortality risk was the highest for perioperative complications, including sepsis (odds ratio 4.95, 95% CI [4.32-5.67]). Conversely, functional impairment was best predicted by the "full-risk factor" model and depended strongly on chronic preoperative comorbidities | ||
| 520 | |a CONCLUSIONS: The RCRI provides a simple but adequate model of preoperative risk factors for in-hospital mortality after perioperative AMI | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a risk stratification | |
| 650 | 4 | |a statistical modeling | |
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| 700 | 1 | |a Nagele, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Rubin, Daniel S |e verfasserin |4 aut | |
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