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Titolo:
Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery - An observational study
Autore:
Polanczyk, CA; Rohde, LE; Goldman, L; Cook, EF; Thomas, EJ; Marcantonio, ER; Mangione, CM; Lee, TH;
Indirizzi:
Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med,Sect Clin Epidemiol,Div Gen Med, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 demiol,Div Gen Med, Boston, MA 02115 USA Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med,Div Cardiovasc, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 Med,Div Cardiovasc, Boston, MA 02115 USA Univ Calif San Francisco, Sch Med, Dept Med, San Francisco, CA 94143 USA Univ Calif San Francisco San Francisco CA USA 94143 ancisco, CA 94143 USA Univ Calif Los Angeles, Sch Med, Dept Med, Los Angeles, CA 90024 USA Univ Calif Los Angeles Los Angeles CA USA 90024 Los Angeles, CA 90024 USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 3, volume: 286, anno: 2001,
pagine: 309 - 314
SICI:
0098-7484(20010718)286:3<309:RHCACC>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
PULMONARY-ARTERY CATHETERIZATION; PERIPHERAL VASCULAR-SURGERY; MYOCARDIAL-INFARCTION; VENTRICULAR ARRHYTHMIAS; RISK; INDEX; PREVENTION; ISCHEMIA; DISEASE; TRIAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
30
Recensione:
Indirizzi per estratti:
Indirizzo: Lee, TH Partners Community HealthCare Inc, Suite 1150,Prudential Tower,800Boylston St, Boston, MA 02199 USA Partners Community HealthCare Inc Suite 1150,Prudential Tower,800 Boylston St Boston MA USA 02199
Citazione:
C.A. Polanczyk et al., "Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery - An observational study", J AM MED A, 286(3), 2001, pp. 309-314

Abstract

Context Right heart catheterization (RHC) is commonly performed before high-risk noncardiac surgery, but the benefit: of this strategy remains unproven. Objective To evaluate the relationship between use of perioperative RHC and postoperative cardiac complication rates in patients undergoing major noncardiac surgery. Design Prospective, observational cohort study. Setting Tertiary care teaching hospital in the United States. Patients Patients (n=4059 aged greater than or equal to 50 years) who underwent major elective noncardiac procedures with an expected length of stay of 2 or more days between July 18, 1989, and February 28, 1994, Two hundredtwenty one patients had RHC and 3838 did not. Main Outcome Measure Combined end point of major postoperative cardiac events, including myocardial infarction, unstable angina, cardiogenic pulmonary edema, ventricular fibrillation, documented ventricular tachycardia or primary cardiac arrest, and sustained complete heart block, classified by a reviewer blinded to preoperative data. Results Major cardiac events occurred in 171 patients (4.2%). Patients whounderwent perioperative RHC had a 3-fold increase in incidence of major postoperative cardiac events (34 [15.4%] vs 137 [3.6%]; P<.001). In multivariate analyses, the adjusted odds ratios (ORs) for postoperative major cardiac and noncardiac events in patients undergoing RHC were 2.0 (95% confidenceinterval [CI], 1.3-3.2) and 2.1 (95% CI, 1.2-3.5), respectively. In a case-control analysis of a subset of 215 matched pairs of patients who did and did not undergo RHC, adjusted for propensity of RHC and type of procedure, patients who underwent perioperative RHC also had increased risk of postoperative congestive heart failure (OR, 2.9; 95% CI, 1.4-6.2) and major noncardiac events (OR, 2.2; 95% CI, 1.4-4.9). Conclusions No evidence was found of reduction in complication rates associated with use of perioperative RHC in this population. Because of the morbidity and the high costs associated with RHC, the impact of this intervention in perioperative care should be evaluated in randomized trials.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/04/20 alle ore 14:59:32