Vassileva Christina M, Kwedar Kathleen, Boley Theresa, Markwell Stephen, Hazelrigg Stephen
Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois 62794-9638, USA.
J Heart Valve Dis. 2013 Jan;22(1):14-9.
Cardiovascular disease is a frequent cause of death in patients with rheumatoid arthritis (RA). Valvular involvement is common, most frequently affecting the mitral valve. Whether RA is an additional risk factor for patients undergoing mitral surgery has not been studied. The study aim was to examine procedure selection and outcome in patients with RA compared to that in patients without RA.
The 2005-2008 NIS database was searched to identify patients aged > or = 18 years undergoing isolated mitral valve repair or replacement. Patients with and without RA were compared on their baseline characteristics and hospital outcomes. Within the subset of patients with RA, patients undergoing repair and replacement were compared.
RA patients comprised 1.0% (710/70,969) of the population, and were older, more likely to be female, and had a higher Charlson comorbidity index. The repair rate for RA patients was lower (37.6% versus 45.5%, p = 0.0401). The hospital length of stay (OR = 1.27, 95% CI 0.88-1.82, p = 0.1946) and hospital mortality (OR = 0.57, 95% CI 0.19-1.72, p = 0.3081) were similar for patients with and without RA. Baseline characteristics were similar between mitral valve repair and replacement subsets. The median LOS was higher for replacement (10 days versus 7 days, p = 0.0242). Hospital mortality was similar for repair versus replacement (OR = 1.17, 95% CI 0.10-13.46, p = 0.8983).
RA does not appear to be an additional risk factor for adverse outcome following isolated mitral valve surgery. Although repair rates were lower for patients with RA, hospital mortality was similar to that in patients without RA. Within the RA subset, hospital mortality rates between mitral valve repair and replacement were similar.
心血管疾病是类风湿关节炎（RA）患者常见的死亡原因。瓣膜受累很常见，最常影响二尖瓣。RA是否是二尖瓣手术患者的额外风险因素尚未得到研究。本研究的目的是比较RA患者与非RA患者的手术选择和结局。
检索2005 - 2008年国家住院样本（NIS）数据库，以识别年龄≥18岁接受单纯二尖瓣修复或置换的患者。比较有RA和无RA患者的基线特征及住院结局。在RA患者亚组中，比较接受修复和置换的患者。
RA患者占总体人群的1.0%（710/70969），年龄更大，女性比例更高，Charlson合并症指数更高。RA患者的修复率较低（37.6%对45.5%，p = 0.0401）。有RA和无RA患者的住院时间（OR = 1.27，95%CI 0.88 - 1.82，p = 0.1946）和住院死亡率（OR = 0.57，95%CI 0.19 - 1.72，p = 0.3081）相似。二尖瓣修复和置换亚组的基线特征相似。置换患者的中位住院时间更高（10天对7天，p = 0.0242）。修复与置换的住院死亡率相似（OR = 1.17，95%CI 0.10 - 13.46，p = 0.8983）。
RA似乎不是单纯二尖瓣手术后不良结局的额外风险因素。虽然RA患者的修复率较低，但住院死亡率与非RA患者相似。在RA亚组中，二尖瓣修复和置换的住院死亡率相似。
