类风湿关节炎患者围手术期全因死亡率和心血管事件：与未受影响的对照组及糖尿病患者的比较
Perioperative all-cause mortality and cardiovascular events in patients with rheumatoid arthritis: comparison with unaffected controls and persons with diabetes mellitus.
作者信息
Yazdanyar Ali, Wasko Mary Chester, Kraemer Kevin L, Ward Michael M
机构信息
Section of Hospital Medicine, Department of Medicine, Reading Hospital and Medical Center, Sixth Avenue and Spruce Street, West Reading, PA 19612, USA.
出版信息
Arthritis Rheum. 2012 Aug;64(8):2429-37. doi: 10.1002/art.34428.
OBJECTIVE
Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) burden similar to that of diabetes mellitus (DM). This risk may warrant preoperative CV assessment as is performed for patients with DM. We aimed to determine whether the risks of perioperative death and CV events among patients with RA differed from those among unaffected controls and patients with DM.
METHODS
We used 1998-2002 data from the Nationwide Inpatient Sample (NIS) database of the Healthcare Cost Utilization Project (HCUP) to identify hospitalizations of patients undergoing elective noncardiac surgery. Using established guidelines, surgical procedures were categorized as either low risk, intermediate risk, or high risk of having CV events. Logistic models provided the adjusted odds of study end points in patients with RA, DM, or both relative to patients with neither condition.
RESULTS
Among 7,756,570 patients undergoing a low-risk, intermediate-risk, or high-risk noncardiac procedure, 2.34%, 0.51%, and 2.12%, respectively, had a composite CV event, and death occurred in 1.47%, 0.50%, and 2.59%, respectively. Among those undergoing an intermediate-risk procedure, death was less likely in RA patients than in DM patients (0.30% versus 0.65%; P < 0.001), but the difference in mortality rates among those undergoing low-risk versus high-risk procedures was not significant. Patients with RA were less likely to have a CV event than were patients with DM for procedures of low risk (3.38% versus 5.30%; P < 0.001) and intermediate risk (0.34% versus 1.07%; P < 0.001). In adjusted models, RA was not independently associated with an increased risk of perioperative death or a CV event.
CONCLUSION
RA was not associated with adverse perioperative CV risk or mortality risk, which suggests that current perioperative clinical care does not need to be changed in this regard.
目的
类风湿关节炎（RA）与心血管（CV）负担增加相关，类似于糖尿病（DM）。这种风险可能需要像对糖尿病患者那样进行术前心血管评估。我们旨在确定RA患者围手术期死亡和心血管事件的风险与未受影响的对照组及糖尿病患者的风险是否不同。
方法
我们使用了医疗保健成本和利用项目（HCUP）的全国住院样本（NIS）数据库中1998 - 2002年的数据，以识别接受择期非心脏手术患者的住院情况。根据既定指南，手术程序被分类为发生心血管事件的低风险、中风险或高风险。逻辑模型提供了RA患者、DM患者或两者相对于既无RA也无DM患者的研究终点调整后比值比。
结果
在7756570例接受低风险、中风险或高风险非心脏手术的患者中，分别有2.34%、0.51%和2.12%发生了复合心血管事件，死亡发生率分别为1.47%、0.50%和2.59%。在接受中风险手术的患者中，RA患者死亡的可能性低于DM患者（0.30%对0.65%；P < 0.001），但在接受低风险与高风险手术患者中的死亡率差异不显著。对于低风险手术（3.38%对5.30%；P < 0.001）和中风险手术（0.34%对1.07%；P < 0.001），RA患者发生心血管事件的可能性低于DM患者。在调整模型中，RA与围手术期死亡或心血管事件风险增加无独立相关性。
结论
RA与围手术期不良心血管风险或死亡风险无关，这表明目前在这方面围手术期临床护理无需改变。
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