心力衰竭患者心脏移植与随后卒中风险的关系。
Association Between Heart Transplantation and Subsequent Risk of Stroke Among Patients With Heart Failure.
机构信息
From the Clinical and Translational Neuroscience Unit (A.E.M., M.L.C., N.S.P., S.B.M., B.B.N., C.I., H.K.).
Feil Family Brain and Mind Research Institute, Department of Neurology (A.E.M., S.B.M., B.B.N., C.I., H.K.).
出版信息
Stroke. 2019 Mar;50(3):583-587. doi: 10.1161/STROKEAHA.118.023622.
Background and Purpose- It is uncertain whether heart transplantation decreases the risk of stroke. The objective of our study was to determine whether heart transplantation is associated with a decreased risk of subsequent stroke among patients with heart failure awaiting transplantation. Methods- We performed a retrospective cohort study using administrative data from New York, California, and Florida between 2005 and 2015. Individuals with heart failure awaiting heart transplantation were identified using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for heart failure in combination with code V49.83 for awaiting organ transplant status. Individuals with prior stroke were excluded. Our primary exposure variable was heart transplantation, modeled as a time-varying covariate and defined by procedure code 37.51. The primary outcome was stroke, defined as the composite of ischemic and hemorrhagic stroke. Survival statistics were used to calculate stroke incidence, and Cox proportional hazards analysis was used to determine the association between heart transplantation and stroke while adjusting for demographics, stroke risk factors, Elixhauser comorbidities, and implantation of a left ventricular assist device. Results- We identified 7848 patients with heart failure awaiting heart transplantation, of whom 1068 (13.6%) underwent heart transplantation. During a mean follow-up of 2.7 years, we identified 428 strokes. The annual incidence of stroke was 0.7% (95% CI, 0.5%-1.0%) after heart transplantation versus 2.4% (95% CI, 2.2%-2.6%) among those awaiting heart transplantation. After adjustment for potential confounders, heart transplantation was associated with a lower risk of stroke (hazard ratio, 0.4; 95% CI, 0.2-0.6). Conclusions- Heart transplantation is associated with a decreased risk of stroke among patients with heart failure awaiting transplantation.
背景与目的- 心脏移植是否降低中风风险尚不确定。本研究旨在确定心脏移植是否降低等待心脏移植的心衰患者发生中风的风险。
方法- 我们使用 2005 年至 2015 年纽约、加利福尼亚和佛罗里达州的行政数据进行回顾性队列研究。通过心脏衰竭的先前验证的国际疾病分类，第九修订版，临床修正诊断代码与等待器官移植状态的代码 V49.83 相结合，确定等待心脏移植的心衰患者。排除有既往中风的患者。我们的主要暴露变量是心脏移植，作为一个随时间变化的协变量建模，定义为程序代码 37.51。主要结局是中风，定义为缺血性和出血性中风的复合。生存统计用于计算中风发生率，Cox 比例风险分析用于确定心脏移植与中风之间的关联，同时调整人口统计学、中风危险因素、Elixhauser 合并症和左心室辅助装置的植入情况。
结果- 我们确定了 7848 例等待心脏移植的心衰患者，其中 1068 例（13.6%）接受了心脏移植。在平均 2.7 年的随访中，我们确定了 428 例中风。心脏移植后中风的年发生率为 0.7%（95% CI，0.5%-1.0%），而在等待心脏移植的患者中为 2.4%（95% CI，2.2%-2.6%）。在调整潜在混杂因素后，心脏移植与较低的中风风险相关（风险比，0.4；95% CI，0.2-0.6）。
结论- 心脏移植与等待移植的心衰患者中风风险降低相关。
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