Risk factors and outcomes of myocardial injury after non-cardiac surgery in high-risk patients who underwent radical cystectomy

被引:14
作者
Yu, Jihion [1 ]
Lim, Bumjin [2 ]
Lee, Yongsoo [1 ]
Park, Jun-Young [1 ]
Hong, Bumsik [2 ]
Hwang, Jai-Hyun [1 ]
Kim, Young-Kug [1 ]
机构
[1] Univ Ulsan, Dept Anesthesiol & Pain Med, Coll Med, Asan Med Ctr, 88 Olymp Ro 43 Gil, Seoul 05505, South Korea
[2] Univ Ulsan, Asan Med Ctr, Dept Urol, Coll Med, Seoul, South Korea
关键词
high-risk patients; myocardial injury after non-cardiac surgery; radical cystectomy; PERIOPERATIVE CARDIAC EVENTS; ACUTE KIDNEY INJURY; TASK-FORCE; ASSOCIATION; MORTALITY; COMPLICATIONS; TRANSFUSION; DYSFUNCTION; MANAGEMENT; VELOCITY;
D O I
10.1097/MD.0000000000022893
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Radical cystectomy is considered the standard treatment for patients with muscle-invasive bladder tumors and has high postoperative complication rates among urological surgeries. High-risk patients, defined as those >= 45 years of age with history of coronary artery disease, stroke, or peripheral artery disease or those >= 65 years of age, can have a higher incidence of cardiac complications. Therefore, we evaluated the incidence, risk factors, and outcomes of myocardial injury after non-cardiac surgery (MINS) in high-risk patients who underwent radical cystectomy. This retrospective observational study analyzed 248 high-risk patients who underwent radical cystectomy. MINS was defined as serum troponin I concentration >= 0.04 mg/L within postoperative 3 days. The risk factors for MINS were evaluated by multivariate logistic regression analysis. Postoperative outcomes were evaluated. The 1-year survival after radical cystectomy was also compared between patients who developed MINS (MINS group) and those who did not (non-MINS group) by Kaplan-Meier analysis. MINS occurred in 35 patients (14.1%). Multivariate logistic regression analysis showed that early diastolic transmitral filling velocity (E)/early diastolic septal mitral annular velocity (E') ratio (odds ratio = 1.102, 95% confidence interval [1.009-1.203], P = .031) and large volume blood transfusion (odds ratio = 2.745, 95% confidence interval [1.131-6.664], P = .026) were significantly associated with MINS in high-risk patients who underwent radical cystectomy. Major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group (17.1% vs 6.1%, P = .035; 28.6% vs 12.7%, P = .021, respectively). Kaplan-Meier analysis showed significantly lower 1-year survival in the MINS group than in the non-MINS group (P = .010). MINS occurred in 14.1% of patients. High E/E' ratio and large volume blood transfusion were risk factors for MINS in high-risk patients who underwent radical cystectomy. Postoperative major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group. Preoperative evaluation of risk factors for MINS may provide useful information to detect cardiovascular complications after radical cystectomy in high-risk patients.
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收藏
页数:9
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