Tropea Joanne, Brand Caroline A, Bohensky Megan, Van Doornum Sharon
Melbourne EpiCentre, The Royal Melbourne Hospital and University of Melbourne, Grattan Street, Parkville, VIC, 3050, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
Arthritis Res Ther. 2016 Mar 28;18:69. doi: 10.1186/s13075-016-0958-5.
Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population.
Individuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken.
A total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 %) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 % CI 0.96-2.33), all-cause death was 1.85 (95 % CI 1.09-3.13) and cardiovascular death was 1.90 (95 % CI 1.07-3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 % CI 1.27-2.28), all-cause death was 2.18 (95 % CI 1.66-2.86) and cardiovascular death was 2.30 (95 % CI 1.65-3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 % CI 1.24-4.34) and 12 months (adjusted OR 2.20; 95 % CI 1.47-3.30) compared to those without RA, but no difference in odds of short term mortality were found.
Following an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.
与普通人群相比，类风湿性关节炎（RA）患者发生心肌梗死（MI）及心肌梗死后死亡的风险更高。在之前一项比较RA患者与对照组心肌梗死后治疗情况的研究中，我们注意到，RA患者中经历过外科手术后发生心肌梗死的比例更高。本研究旨在比较RA患者与普通人群关节手术后6周和12个月时发生心肌梗死及死亡的风险。
从常规收集的医院管理数据中确定2000年7月1日至2007年6月30日期间在澳大利亚维多利亚州接受关节手术的个体。进行逻辑回归分析，以检验在调整年龄、性别、合并症、社会经济状况、患者类型和入院类型后，RA患者与非RA患者发生6周和12个月心肌梗死及死亡的几率。对全髋关节和膝关节置换术进行亚组分析。
240,571名个体共发生308,589例关节手术，其中RA患者有3654例（1.2%）。关节手术后6周，心肌梗死的调整比值比（OR）为1.50（95%CI 0.96 - 2.33），全因死亡为1.85（95%CI 1.09 - 3.13），心血管死亡为1.90（95%CI 1.07 - 3.37）。关节手术后12个月，心肌梗死的调整OR为1.70（95%CI 1.27 - 2.28），全因死亡为2.18（95%CI 1.66 - 2.86），心血管死亡为2.30（95%CI 1.65 - 3.22）。在分析髋关节或膝关节置换术以外的关节手术时发现，与非RA患者相比，RA患者在6周内（调整OR 2.32；95%CI 1.24 - 4.34）和12个月内（调整OR 2.20；95%CI 1.47 - 3.30）发生心肌梗死的风险更高，但短期死亡几率无差异。
与普通人群相比，RA患者在经历关节手术后6周时死亡风险显著增加，12个月时心肌梗死及死亡风险显著增加。其原因有待阐明，但在此期间，RA患者在围手术期应被视为高危人群。
