根据疾病活动情况分析炎症性肠病患者首次心肌梗死后的预后：全国性队列研究
Prognosis after first-time myocardial infarction in patients with inflammatory bowel disease according to disease activity: nationwide cohort study.
作者信息
Kristensen Søren Lund, Ahlehoff Ole, Lindhardsen Jesper, Erichsen Rune, Lamberts Morten, Khalid Usman, Nielsen Ole Haagen, Torp-Pedersen Christian, Gislason Gunnar Hilmar, Hansen Peter Riis
机构信息
From the Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.), Department of Cardiology, Copenhagen University Hospital, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital, Herlev, Denmark (O.H.N.), Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
出版信息
Circ Cardiovasc Qual Outcomes. 2014 Nov;7(6):857-62. doi: 10.1161/CIRCOUTCOMES.114.000918. Epub 2014 Oct 14.
BACKGROUND
Inflammatory bowel disease (IBD) is associated with increased cardiovascular risk. We examined the effect of active IBD on major adverse cardiovascular outcomes after myocardial infarction (MI).
METHODS AND RESULTS
In nationwide registries, we identified 86 790 patients with first-time MI from the period 2002 to 2011. A total of 1030 patients had IBD, and we categorized their disease activity stages into either flare (120 days), persistent (>120 days) activity, or remission. Short-term mortality was estimated in a logistic regression-model, whereas risk of recurrent MI, all-cause mortality, and a composite of recurrent MI, cardiovascular death, and stroke were estimated by Cox regression-models. Odds ratio of death during hospitalization or within 30 days of discharge (n=13 339) corresponded to 3.29 (95% confidence interval [CI], 1.98-5.45) for patients in IBD flares, 1.62 (95% CI, 0.95-2.77) for persistent activity, and 0.97 (95% CI, 0.78-1.19) for remission when compared with the non-IBD group. Among 73 451 patients, including 863 with IBD, alive 30 days after discharge, IBD was associated with hazard ratios of 1.21 (95% CI, 0.99-1.49) for recurrent MI, 1.14 (95% CI, 1.01-1.28) for all-cause mortality, and 1.17 (95% CI, 1.03-1.34) for the composite end point. When compared with the non-IBD group, IBD flares, in particular, were associated with increased risks of recurrent MI (hazard ratio, 3.09; 95% CI, 1.79-5.32), all-cause mortality (hazard ratio, 2.25; 95% CI, 1.61-3.15), and the composite end point (hazard ratio, 2.04; 95% CI, 1.35-3.06), whereas no increased risk was identified in remission.
CONCLUSIONS
Active inflammatory bowel disease worsens prognosis after MI, in particular, in relation with flares.
背景
炎症性肠病（IBD）与心血管疾病风险增加相关。我们研究了活动性IBD对心肌梗死（MI）后主要不良心血管事件的影响。
方法与结果
在全国性登记处中，我们确定了2002年至2011年期间86790例首次发生MI的患者。共有1030例患者患有IBD，我们将其疾病活动阶段分为发作期（120天）、持续活动期（>120天）或缓解期。采用逻辑回归模型估计短期死亡率，而采用Cox回归模型估计复发性MI、全因死亡率以及复发性MI、心血管死亡和中风的复合终点的风险。与非IBD组相比，IBD发作期患者住院期间或出院后30天内死亡的比值比为3.29（95%置信区间[CI]，1.98 - 5.45），持续活动期为1.62（95% CI，0.95 - 2.77），缓解期为0.97（95% CI，0.78 - 1.19）。在出院后30天存活的73451例患者（包括863例IBD患者）中，IBD与复发性MI的风险比为1.21（95% CI，0.99 - 1.49），全因死亡率的风险比为1.14（95% CI，1.01 - 1.28），复合终点的风险比为1.17（95% CI，1.03 - 1.34）。特别是与非IBD组相比，IBD发作期与复发性MI风险增加（风险比，3.09；95% CI，1.79 - 5.32）、全因死亡率增加（风险比，2.25；95% CI，1.61 - 3.15）以及复合终点风险增加（风险比，2.04；95% CI，1.35 - 3.06）相关，而缓解期未发现风险增加。
结论
活动性炎症性肠病会使MI后的预后恶化，尤其是与发作期相关。
Zotero 插件