Johansson Carin Starkhammar, Ravald Nils, Pagonis Christos, Richter Arina
Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
J Periodontol. 2014 Mar;85(3):417-25. doi: 10.1902/jop.2013.120730. Epub 2013 May 31.
This study examines whether preceding assessment of periodontal status in patients with established coronary artery disease (CAD) can predict future CAD endpoints (myocardial infarction, new revascularization procedure, or CAD-related death) during 8-year follow-up and whether the changes in periodontal status over time differ in patients with CAD compared with healthy controls.
In 2003, periodontal status was examined in 161 patients with CAD who underwent percutaneous coronary intervention or coronary artery bypass graft due to significant stenosis in the coronary arteries and 162 controls without CAD. Eight years later, 126 patients with CAD (102 males and 24 females, mean age: 68 ± 8.9 years) and 121 controls (101 males and 20 females, mean age: 69 ± 9.0 years) were reexamined periodontally. A standard classification of periodontal disease in three groups (mild, moderate, and severe) was used. CAD endpoints during follow-up were obtained by review of medical records. CAD as cause of death was confirmed from the Swedish Cause of Death Register.
No significant differences were found among patients with CAD, with or without CAD-related endpoints at 8-year follow-up, and severity of periodontitis at baseline (P = 0.7). CAD did not influence the incidence or severity of periodontitis. Significant differences were found at the final examination in periodontitis prevalence and severity (P = 0.001), number of teeth (P = 0.006), probing depth 4 to 6 mm (P = 0.016), bleeding on probing (P = 0.001), and radiographic bone level (P = 0.042) between CAD patients and controls, all in favor of controls.
The study results did not show a significant association during 8 years among CAD endpoints and periodontal status at baseline. The progression of periodontitis was low in both groups, although the higher proportion of individuals with severe periodontitis among patients with CAD compared with controls remained unchanged over the 8-year follow-up. Further long-term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD, in terms of endpoints including myocardial infarction, new revascularization procedure, and CAD-related death.
本研究旨在探讨已确诊冠心病（CAD）患者的牙周状况前期评估能否预测8年随访期间未来的CAD终点事件（心肌梗死、新的血运重建手术或CAD相关死亡），以及CAD患者与健康对照者相比，牙周状况随时间的变化是否存在差异。
2003年，对161例因冠状动脉严重狭窄而接受经皮冠状动脉介入治疗或冠状动脉搭桥术的CAD患者以及162例无CAD的对照者进行了牙周状况检查。8年后，对126例CAD患者（102例男性，24例女性，平均年龄：68±8.9岁）和121例对照者（101例男性，20例女性，平均年龄：69±9.0岁）再次进行牙周检查。采用牙周疾病的标准分类法将其分为三组（轻度、中度和重度）。通过查阅病历获取随访期间的CAD终点事件。从瑞典死亡原因登记处确认CAD作为死亡原因。
在8年随访时，有或无CAD相关终点事件的CAD患者与基线时的牙周炎严重程度之间未发现显著差异（P = 0.7）。CAD并未影响牙周炎的发病率或严重程度。在最终检查中，CAD患者与对照者在牙周炎患病率和严重程度（P = 0.001）、牙齿数量（P = 0.006）、探诊深度4至6毫米（P = 0.016）、探诊出血（P = 0.001）以及影像学骨水平（P = 0.042）方面存在显著差异，所有这些均有利于对照者。
研究结果未显示在8年期间CAD终点事件与基线牙周状况之间存在显著关联。两组的牙周炎进展都较低，尽管与对照者相比，CAD患者中重度牙周炎个体的比例在8年随访期间保持不变。需要进一步的长期前瞻性研究来表明，就包括心肌梗死、新的血运重建手术和CAD相关死亡在内的终点事件而言，牙周炎是否可被视为CAD的风险因素或预后因素。
