入院前使用钙通道阻滞剂或β受体阻滞剂治疗对卒中后短期死亡率的影响：一项全国性队列研究
Impact of preadmission treatment with calcium channel blockers or beta blockers on short-term mortality after stroke: a nationwide cohort study.
作者信息
Sundbøll Jens, Schmidt Morten, Horváth-Puhó Erzsébet, Christiansen Christian F, Pedersen Lars, Bøtker Hans Erik, Sørensen Henrik T
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, DK-8200, Denmark.
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgårdsvej 100, Aarhus N, DK-8200, Denmark.
出版信息
BMC Neurol. 2015 Mar 7;15:24. doi: 10.1186/s12883-015-0279-3.
BACKGROUND
The prognostic impact of preadmission use of calcium channel blockers (CCBs) and beta blockers (BBs) on stroke mortality remains unclear. We aimed to examine whether preadmission use of CCBs or BBs was associated with improved short-term mortality following ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH).
METHODS
We conducted a nationwide population-based cohort study using Danish medical registries. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012 and their comorbidities. We defined CCB/BB use as current use, former use, or non-use. Current use was further classified as new or long-term use. We used Cox regression modeling to compute 30-day mortality rate ratios (MRRs) with 95% confidence intervals (CIs), controlling for potential confounders.
RESULTS
We identified 100,043 patients with a first-time stroke. Of these, 83,736 (83.7%) patients had ischemic stroke, 11,779 (11.8%) had ICH, and 4,528 (4.5%) had SAH. Comparing current users of CCBs or BBs with non-users, we found no association with mortality for ischemic stroke [adjusted 30-day MRR = 0.99 (95% CI: 0.94-1.05) for CCBs and 1.01 (95% CI: 0.96-1.07) for BBs], ICH [adjusted 30-day MRR = 1.05 (95% CI: 0.95-1.16) for CCBs and 0.95 (95% CI: 0.87-1.04) for BBs], or SAH [adjusted 30-day MRR = 1.05 (95% CI: 0.85-1.29) for CCBs and 0.89 (95% CI: 0.72-1.11) for BBs]. Former use of CCBs or BBs was not associated with mortality.
CONCLUSIONS
Preadmission use of CCBs or BBs was not associated with 30-day mortality following ischemic stroke, ICH, or SAH.
背景
入院前使用钙通道阻滞剂（CCB）和β受体阻滞剂（BB）对卒中死亡率的预后影响尚不清楚。我们旨在研究入院前使用CCB或BB是否与缺血性卒中、脑出血（ICH）或蛛网膜下腔出血（SAH）后的短期死亡率改善相关。
方法
我们使用丹麦医疗登记系统进行了一项全国性的基于人群的队列研究。我们确定了2004年至2012年间首次住院诊断为卒中的所有患者及其合并症。我们将CCB/BB的使用定义为当前使用、既往使用或未使用。当前使用进一步分为新使用或长期使用。我们使用Cox回归模型计算30天死亡率比值（MRR）及其95%置信区间（CI），并控制潜在的混杂因素。
结果
我们确定了100,043例首次发生卒中的患者。其中，83,736例（83.7%）为缺血性卒中，11,779例（11.8%）为ICH，4,528例（4.5%）为SAH。将当前使用CCB或BB的患者与未使用者进行比较，我们发现对于缺血性卒中[CCB的调整后30天MRR = 0.99（95% CI：0.94 - 1.05），BB的调整后30天MRR = 1.01（95% CI：0.96 - 1.07）]、ICH[CCB的调整后30天MRR = 1.05（95% CI：0.95 - 1.16），BB的调整后30天MRR = 0.95（95% CI：0.87 - 1.04）]或SAH[CCB的调整后30天MRR = 1.05（95% CI：0.85 - 1.29），BB的调整后30天MRR = 0.89（95% CI：0.72 - 1.11）]，均与死亡率无关。既往使用CCB或BB与死亡率无关。
结论
入院前使用CCB或BB与缺血性卒中、ICH或SAH后的30天死亡率无关。
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