Van Doornum Sharon, Bohensky Megan, Tacey Mark A, Brand Caroline A, Sundararajan Vijaya, Wicks Ian P
Melbourne EpiCentre, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, 3050, Australia.
The University of Melbourne, Grattan Street, Parkville, Victoria, 3050, Australia.
Arthritis Res Ther. 2015 Feb 27;17(1):38. doi: 10.1186/s13075-015-0552-2.
It is now well-recognised that patients with autoimmune rheumatic disease (AIRD) have a predisposition to cardiovascular disease that results in increased morbidity and mortality. Following myocardial infarction (MI), patients with rheumatoid arthritis have been shown to have an increased case fatality rate; however, this has not been demonstrated in other forms of AIRD. The aim of this study was to compare case fatality rates following a first MI in patients with AIRD versus the general population. The secondary aim was to compare revascularisation treatment following MI in patients with AIRD versus the general population.
A retrospective cohort study using two population-based linked databases was undertaken. Cases of first MI from July 2001 to June 2007 were identified based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, codes. Thirty-day and one-year mortality rates were calculated (all-cause and cardiovascular causes of death). Logistic regression models were fitted to calculate the odds of mortality by AIRD status with adjustment for relevant characteristics.
There were 79,390 individuals with a first MI, of whom 1,409 (1.8%) had AIRD. After adjusting for relevant covariates, the odds ratio (OR) for 30-day cardiovascular mortality in patients with AIRD was 1.44 (95% confidence interval (CI): 1.25 to 1.66), and the OR for 12-month cardiovascular mortality was 1.71 (95% CI: 1.51 to 1.94). The 90-day adjusted odds of percutaneous transluminal coronary angioplasty and coronary artery bypass graft were significantly lower in the AIRD group compared with controls (OR: 0.81, 95% CI: 0.70 to 0.94, and OR: 0.52, 95% CI: 0.39 to 0.69, respectively).
We identified a higher risk-adjusted mortality rate for the majority of patients with AIRD at 30 days and 12 months after first MI. We also identified lower post-MI revascularisation rates in the AIRD group, suggesting there may be current gaps in cardiovascular treatment for patients with AIRD.
目前人们已经充分认识到，自身免疫性风湿病（AIRD）患者易患心血管疾病，这会导致发病率和死亡率上升。心肌梗死（MI）后，类风湿关节炎患者的病死率已被证明有所增加；然而，其他形式的AIRD尚未得到证实。本研究的目的是比较AIRD患者与普通人群首次心肌梗死后的病死率。次要目的是比较AIRD患者与普通人群心肌梗死后的血运重建治疗情况。
采用两个基于人群的关联数据库进行回顾性队列研究。根据《国际疾病和相关健康问题统计分类，第十次修订版，澳大利亚修改版》代码，确定2001年7月至2007年6月首次心肌梗死的病例。计算30天和1年的死亡率（全因死亡和心血管疾病死亡原因）。采用逻辑回归模型计算按AIRD状态调整相关特征后的死亡几率。
共有79390例首次心肌梗死患者，其中1409例（1.8%）患有AIRD。在调整相关协变量后，AIRD患者30天心血管死亡率的比值比（OR）为1.44（95%置信区间（CI）：1.25至1.66），12个月心血管死亡率的OR为1.71（95%CI：1.51至1.94）。与对照组相比，AIRD组经皮腔内冠状动脉成形术和冠状动脉旁路移植术的90天调整后几率显著降低（OR分别为：0.81，95%CI：0.70至0.94；OR为0.52，95%CI：0.39至0.69）。
我们发现，大多数AIRD患者在首次心肌梗死后30天和12个月的风险调整死亡率较高。我们还发现AIRD组心肌梗死后血运重建率较低，这表明目前AIRD患者的心血管治疗可能存在差距。
