类风湿关节炎患者首次急性心血管事件后的病死率增加。

Increased case fatality rates following a first acute cardiovascular event in patients with rheumatoid arthritis.

作者信息

Van Doornum S, Brand C, King B, Sundararajan V

机构信息

Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Post Office Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.

出版信息

Arthritis Rheum. 2006 Jul;54(7):2061-8. doi: 10.1002/art.21932.

DOI:10.1002/art.21932

PMID:16802340

Abstract

OBJECTIVE

Among patients with rheumatoid arthritis (RA), cardiovascular mortality is increased compared with the rate among unaffected peers. In this study, 30-day mortality rates following a first acute cardiovascular event (myocardial infarction or stroke) were compared between RA patients and the general population.

METHODS

All cases of a first acute cardiovascular event between July 1, 2001 and November 30, 2003 in Victoria, Australia were identified from hospital discharge data. Individuals were classified as having RA when an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification code for RA was recorded at the index admission or during the previous 5 years. Thirty-day mortality rates were determined from linkage to the state death registry.

RESULTS

A total of 29,924 patients experienced a first cardiovascular event during the study period, 359 (1.2%) of whom had RA. Thirty-day cardiovascular mortality was 17.6% in RA patients versus 10.8% in non-RA patients. In fully adjusted models, the odds ratio (OR) for cardiovascular death in RA patients following a first acute cardiovascular event was 1.6 (95% confidence interval [95% CI] 1.2-2.2). Analysis of index event subgroups revealed that this increased case fatality rate in patients with RA was accounted for almost entirely by excess deaths following myocardial infarction. The adjusted ORs for cardiovascular death in RA after myocardial infarction and stroke were 1.9 (95% CI 1.3-2.7) and 1.2 (95% CI 0.7-2.0), respectively.

CONCLUSION

RA patients have a substantially increased risk of 30-day case fatality following myocardial infarction, but not stroke, compared with non-RA patients. This higher case fatality rate is likely to contribute to the observed overall excess of cardiovascular deaths in RA populations.

摘要

目的

类风湿关节炎（RA）患者的心血管疾病死亡率高于未患病的同龄人。本研究比较了RA患者与普通人群首次急性心血管事件（心肌梗死或中风）后的30天死亡率。

方法

从澳大利亚维多利亚州2001年7月1日至2003年11月30日期间所有首次急性心血管事件的病例中，通过医院出院数据进行识别。当在首次入院或之前5年内记录到国际疾病分类第九版临床修订本（ICD - 9 - CM）或国际疾病及相关健康问题统计分类第十版澳大利亚修订版中RA的编码时，个体被分类为患有RA。通过与州死亡登记处的关联确定30天死亡率。

结果

在研究期间，共有29924名患者经历了首次心血管事件，其中359名（1.2%）患有RA。RA患者的30天心血管死亡率为17.6%，而非RA患者为10.8%。在完全调整模型中，RA患者首次急性心血管事件后心血管死亡的比值比（OR）为1.6（95%置信区间[95%CI]1.2 - 2.2）。对首次事件亚组的分析表明，RA患者中这种增加的病死率几乎完全是由心肌梗死后的额外死亡造成的。心肌梗死和中风后RA患者心血管死亡的调整后OR分别为1.9（95%CI 1.3 - 2.7）和1.2（95%CI 0.7 - 2.0）。