秋水仙碱对胸外科手术患者心血管事件的预防作用：基于CAD状态的二次分析
本研究为COP-AF随机对照试验的事后二次分析，纳入3209例非心脏胸外科手术患者，其中331例（10.3%）合并冠心病。分析评估CAD与术后缺血结局的关联，以及秋水仙碱在不同CAD状态下的效应差异。结果显示CAD患者术后心肌损伤及死亡、卒中复合结局风险显著升高，但秋水仙碱效应在两组间无显著差异。
要点
- 合并CAD的胸外科手术患者术后MINS风险较非CAD患者高约53%。
- 秋水仙碱对术后缺血结局的效应在CAD与非CAD患者间无显著差异。
- 该分析样本量有限，不能排除亚组间存在中等程度差异的可能。
核心结论
- 合并CAD的胸外科手术患者术后心肌损伤及其他缺血结局风险显著高于非CAD患者。
- 秋水仙碱对术后缺血结局的效应在CAD与非CAD患者间无显著差异。
研究设计与样本
- 本研究为COP-AF随机对照试验的事后探索性二次分析。
- 共纳入3209例非心脏胸外科手术患者，其中331例（10.3%）合并CAD。
- 患者随机接受秋水仙碱0.5 mg或安慰剂，每日两次，持续10天，随访14天。
主要发现
- CAD患者MINS发生率为29.3%（n=97），非CAD患者为18.2%（n=523），校正HR为1.53（95% CI 1.22至1.92；p<0.001）。
- 死亡、卒中或MINS复合结局在CAD患者中为30.2%（n=100），非CAD患者为18.6%（n=535），校正HR为1.53（95% CI 1.22至1.91；p<0.001）。
- 秋水仙碱对MINS的效应在CAD患者中HR为0.82（95% CI 0.55至1.22），非CAD患者为0.91（95% CI 0.77至1.08），交互p=0.61。
- 秋水仙碱对死亡、卒中或MINS复合结局的效应在CAD患者中HR为0.77（95% CI 0.52至1.14），非CAD患者为0.91（95% CI 0.76至1.07），交互p=0.45。
临床怎么用
- 胸外科手术前应识别合并CAD患者，因其术后缺血事件风险显著升高。
- 现有证据不足以支持根据CAD状态差异使用秋水仙碱预防术后缺血事件。
局限性
- 本分析为事后探索性二次分析，样本量有限，不能排除亚组间存在中等程度差异的可能。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Objectives This exploratory post hoc secondary analysis of the Colchicine for the Prevention of Perioperative Atrial Fibrillation (COP-AF) randomised controlled trial evaluated the association between coronary artery disease (CAD) and postoperative ischaemic outcomes after non-cardiac thoracic surgery and assessed whether colchicine had differential effects by CAD status. Methods Patients were randomised to colchicine 0.5 mg or placebo two times per day for 10 days. Follow-up was 14 days. The primary outcome was myocardial injury after non-cardiac surgery (MINS). A key secondary outcome was the composite of death, MINS and stroke. Cox proportional hazards models assessed the association between CAD and outcomes, with interaction terms to explore whether colchicine had differential effects by CAD status. Results Of 3209 patients enrolled, 331 (10.3%) had CAD. MINS occurred in 29.3% (n=97) and 18.2% (n=523) of patients with and without CAD, adjusted HR (aHR) 1.53 (95% CI 1.22 to 1.92; p<0.001). For colchicine versus placebo, the HR for MINS was 0.82 (95% CI 0.55 to 1.22) in CAD versus 0.91 (95% CI 0.77 to 1.08) in non-CAD patients (p for interaction=0.61). Death, stroke or MINS occurred in 30.2% (n=100) vs 18.6% (n=535), respectively (aHR 1.53, 95% CI 1.22 to 1.91; p<0.001). Colchicine HRs were 0.77 (95% CI 0.52 to 1.14) vs 0.91 (95% CI 0.76 to 1.07; p for interaction=0.45). Conclusions Patients with CAD undergoing thoracic surgery had a higher risk of MINS and other ischaemic outcomes than non-CAD patients. There was no evidence that the effect of colchicine differed between patients with and without CAD; however, these analyses were limited by sample size and do not exclude modest differences between subgroups.
引用
- Open Heart：Colchicine to prevent cardiovascular events in thoracic surgery patients with or without coronary artery disease: a secondary analysis
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。