Isogai Toshiaki, Matsui Hiroki, Tanaka Hiroyuki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Heart Vessels. 2017 Oct;32(10):1271-1276. doi: 10.1007/s00380-017-1007-2. Epub 2017 Jun 7.
Although there is reportedly seasonal variation in the occurrence of Takotsubo syndrome (TTS), it is unknown whether there is a relationship between season and patient characteristics, or whether season influences outcomes. Using the Diagnosis Procedure Combination database in Japan, we retrospectively identified 4306 patients (mean age 73.6 years) hospitalized with TTS between January 2011 and December 2013. We divided patients into four groups according to season of admission [n = 914, Spring (March-May); n = 1243, Summer (June-August); n = 1245, Autumn (September-November); n = 904, Winter (December-February)]. The outcomes were in-hospital mortality and cardiovascular complications. We compared patient backgrounds and outcomes across seasons and estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for outcomes in logistic regression analyses adjusted for multiple propensity scores. Although there was no significant difference in age across seasons, the proportion of males differed significantly (from 18.5% in autumn to 23.9% in winter; p = 0.016). The incidence of psychiatric disease (from 4.9% in spring to 7.9% in summer; p = 0.025) and sepsis (from 0.8% in winter to 2.6% in summer; p = 0.019) also differed significantly with season. In-hospital mortality was not significantly influenced by season (p = 0.377): spring, 5.1%; summer, 6.0%; autumn, 4.6%; winter, 6.0%. However, in-hospital mortality ranged widely across months from 3.0% in September to 7.5% in April. The incidence of ventricular tachycardia/fibrillation was significantly different (p = 0.038): spring, 2.2% (reference); summer, 3.3% (aOR 1.46, 95% CI 0.84-2.51); autumn, 2.7% (aOR 1.27, 95% CI 0.72-2.22); winter, 4.4% (aOR 1.92, 95% CI 1.11-3.33). Although season did not appear to influence the in-hospital mortality of TTS, monthly variation may exist in the risk of death in patients with TTS. There were significant seasonal variations in the proportions of males, patients with psychiatric disease or sepsis, and the incidence of ventricular arrhythmias among patients with TTS.
尽管据报道，应激性心肌病（TTS）的发病存在季节性变化，但季节与患者特征之间是否存在关联，或者季节是否会影响预后尚不清楚。我们利用日本的诊断流程组合数据库，回顾性地确定了2011年1月至2013年12月期间因TTS住院的4306例患者（平均年龄73.6岁）。我们根据入院季节将患者分为四组[n = 914，春季（3 - 5月）；n = 1243，夏季（6 - 8月）；n = 1245，秋季（9 - 11月）；n = 904，冬季（12月至次年2月）]。观察指标为住院死亡率和心血管并发症。我们比较了不同季节的患者背景和预后情况，并在对多个倾向得分进行调整的逻辑回归分析中估计了预后的调整优势比（aORs）和95%置信区间（CIs）。尽管各季节患者年龄无显著差异，但男性比例差异显著（从秋季的18.5%到冬季的23.9%；p = 0.016）。精神疾病的发病率（从春季的4.9%到夏季的7.9%；p = 0.025）和脓毒症的发病率（从冬季的0.8%到夏季的2.6%；p = 0.019）也随季节有显著差异。住院死亡率未受季节显著影响（p = 0.377）：春季为5.1%；夏季为6.0%；秋季为4.6%；冬季为6.0%。然而，住院死亡率在各月份之间差异很大，从9月的3.0%到4月的7.
