老年髋部骨折患者术前左心室射血分数与术后主要不良心血管事件的风险分析

Preoperative left ventricular ejection fraction and risk for postoperative major adverse cardiovascular events in elderly patients with hip fracture

目的探讨老年髋部骨折患者术前左心室射血分数(LVEF)与术后主要不良心血管事件(MACE)的发生风险。方法回顾性分析2015年1月至2021年1月期间首都医科大学附属北京安贞医院骨科采用手术治疗的403例老年髋部骨折患者资料。男118例,女285例;年龄80(74,85)岁;骨折类型:股骨颈骨折228例,股骨转子间及转子下骨折175例。161例患者术前合并心血管系统疾病。统计患者术后30 d内MACE的发生情况。根据术后30 d是否发生MACE将患者分为两组:MACE组和无MACE组,比较两组患者的一般资料、LVEF、术前合并心血管疾病情况等指标。根据患者样本分析,绘制受试者工作特征曲线(ROC),确定最佳术前LVEF临界值。根据最佳术前LVEF临界值,分析LVEF与术后MACE的发生风险。结果术后MACE总体发生率为12.4%(50/403)。MACE组与无MACE组患者的术前LVEF[60.0%(56.0%,63.0%)vs.62.0%(60.0%,65.0%)]、术前合并心血管系统疾病比例[74.0%(37/50)vs.35.1%(124/353)]及美国麻醉医师协会分级≥3级的患者比例[90.0%(45/50)vs.74.8%(264/353)]比较差异均有统计学意义(P<0.05)。ROC分析显示:LVEF=60%为预测术后MACE的最佳临界值(曲线下面积=0.680,灵敏度为48.0%,特异度为83.0%)。多因素logistic回归分析结果显示:LVEF<60%及术前合并心血管系统疾病是老年髋部骨折患者术后发生MACE的危险因素。亚组分析显示:无论患者术前是否合并心血管系统疾病,LVEF<60%患者术后MACE的发生率显著高于LVEF≥60%患者,差异均有统计学意义(P<0.05)。结论老年髋部骨折患者术前LVEF<60%是术后发生MACE的危险因素。

Objective To investigate the relationship between preoperative left ventricular ejection fraction(LVEF)and the risk for postoperative major adverse cardiovascular events(MACE)in elderly patients with hip fracture.Methods A retrospective study was conducted to analyze the data of 403 elderly patients with hip fracture who had undergone surgical treatment at Department of Orthopedics,Beijing Anzhen Hospital from January 2015 to January 2021.Gender:118 males and 285 females;age:80(74,85)years;fracture type:228 femoral neck fractures and 175 intertrochanteric(including subtrochanteric)fractures.Cardiovascular disease was complicated in 161 patients before surgery.The incidence of MACE within 30 days after surgery was statistically analyzed.The patients were divided into 2 groups according to whether MACE occurred 30 days after surgery:an MACE group and a non-MACE group.The baseline data,LVEF,preoperative cardiovascular complications,American Society of Anesthesiologists(ASA)grading and other indicators were compared between the 2 groups.Based on patient sample analysis,the receiver operating characteristic curve(ROC)was plotted to determine the optimal cutoff value of preoperative LVEF,according to which the relationship was analyzed between preoperative LVEF and the risk for postoperative MACE.Results The overall incidence of postoperative MACE was 12.4%(50/403).There were statistically significant differences between the MACE group and the non-MACE group in preoperative LVEF[60.0%(56.0%,63.0%)versus 62.0%(60.0%,65.0%)],preoperative cardiovascular complications[74.0%(37/50)versus 35.1%(124/353)]and ASA grade≥3[90.0%(45/50)versus 74.8%(264/353)].ROC analysis showed that LVEF=60%was the optimal threshold for prediction of postoperative MACE(area under curve=0.680,sensitivity 48.0%,and specificity 83.0%).Multivariate logistic regression analysis showed that LVEF<60%and preoperative cardiovascular disease were risk factors for postoperative MACE.Subgroup analysis showed that the incidence of MACE in patients with LVEF<60%was significantly higher than that in patients with LVEF≥60%regardless of preoperative cardiovascular disease(P<0.05).Conclusion Preoperative LVEF<60%is a risk factor for postoperative MACE in elderly patients with hip fracture.