Krannert School of Management, Purdue University, West Lafayette, IN.
Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Am J Med. 2018 May;131(5):574.e1-574.e11. doi: 10.1016/j.amjmed.2017.11.045. Epub 2017 Dec 21.
Cardiovascular disease has become a leading cause of death for patients with paraplegia. Acute myocardial infarction in patients with paraplegia has not been described in the literature. This study investigates clinical features, management strategies, and outcomes of these patients.
Acute myocardial infarction in patients with or without paraplegia was identified in the New York State Inpatient Database between 2007 and 2013. Clinical comorbidities, management strategies and their associated outcomes were compared using propensity score-matching analysis.
Among 402,569 patients with acute myocardial infarction, 1400 had a concomitant diagnosis of paraplegia. Compared with those without, patients with paraplegia were younger, more likely to be black, and had a higher prevalence of hypertension, anemia, congestive heart failure, coagulopathy, and depression, but a lower prevalence of diabetes, hyperlipidemia, obesity, chronic lung disease, and renal failure. Patients with paraplegia were more likely to receive medical therapy without a diagnostic cardiac catheterization than those without (83.7% vs 64.5%, P < .001). Nine percent of patients with paraplegia received revascularization, which was significantly lower than that without paraplegia. In terms of the clinical outcome, patients with paraplegia had higher in-hospital mortality than those without (22.4% vs 16.8%, P < .001). Among the patients with paraplegia, the subcohort that received revascularization had lower in-hospital mortality (9.5% vs 22.0%, P < .01), had shorter length of stay (13.0 vs 16.9 days, P =.08), and higher hospital charges ($130,079 vs $92,125, P < .001) than those without revascularization. Furthermore, the paraplegic subcohort underwent coronary artery bypass grafting that was associated with higher in-hospital mortality (21.7% vs 1.7%, P < .001), longer length of stay (24.8 vs 14.2 days, P < .001), and higher hospital charges ($231,323 vs $144,449, P < .01) than subcohort that received percutaneous coronary intervention.
Acute myocardial infarction patients with concomitant paraplegia had distinct clinical characteristics and comorbidity profiles; were less likely to receive revascularization therapy; and had higher in-hospital mortality. Acute myocardial infarction patient with paraplegia who underwent revascularization were associated with better clinical outcomes, in particular, those who were treated with percutaneous coronary intervention had significantly lower in-hospital mortality than those treated with coronary artery bypass grafting.
心血管疾病已成为截瘫患者的主要死因。文献中并未描述截瘫患者的急性心肌梗死。本研究调查了这些患者的临床特征、治疗策略和结局。
在 2007 年至 2013 年间，从纽约州住院患者数据库中确定了伴有或不伴有截瘫的急性心肌梗死患者。使用倾向评分匹配分析比较了临床合并症、治疗策略及其相关结局。
在 402569 例急性心肌梗死患者中，有 1400 例伴有截瘫。与无截瘫患者相比，截瘫患者更年轻，更可能为黑人，且高血压、贫血、充血性心力衰竭、凝血障碍和抑郁症更为常见，但糖尿病、高血脂、肥胖、慢性肺病和肾衰竭的患病率较低。与无截瘫患者相比，截瘫患者更倾向于接受无诊断性心导管检查的药物治疗（83.7%比 64.5%，P<.001）。9%的截瘫患者接受了血运重建，明显低于无截瘫患者。就临床结局而言，截瘫患者的院内死亡率高于无截瘫患者（22.4%比 16.8%，P<.001）。在截瘫患者亚组中，接受血运重建的患者院内死亡率较低（9.5%比 22.0%，P<.01），住院时间较短（13.0 天比 16.9 天，P=.08），住院费用较高（$130079 比 $92125，P<.001）。此外，接受冠状动脉旁路移植术的截瘫亚组患者院内死亡率更高（21.7%比 1.7%，P<.001），住院时间更长（24.8 天比 14.2 天，P<.001），住院费用更高（$231323 比 $144449，P<.01）。
伴有截瘫的急性心肌梗死患者具有明显的临床特征和合并症特征；更不可能接受血运重建治疗；且院内死亡率较高。接受血运重建的截瘫急性心肌梗死患者的临床结局较好，特别是接受经皮冠状动脉介入治疗的患者院内死亡率明显低于接受冠状动脉旁路移植术的患者。
