Raita Yoshihiko, Camargo Carlos A, Faridi Mohammad Kamal, Brown David F M, Shimada Yuichi J, Hasegawa Kohei
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol Pract. 2020 Jan;8(1):188-194.e8. doi: 10.1016/j.jaip.2019.06.043. Epub 2019 Jul 16.
Patients with asthma have a high incidence of acute myocardial infarction and ischemic stroke.
To investigate the acute effect of asthma exacerbation on these cardiovascular events.
Using population-based inpatient data of 3 geographically diverse US states (Florida, Nebraska, and New York) during the period 2011 to 2014, we conducted a self-controlled case series study of adults (aged ≥40 years) hospitalized with asthma exacerbation. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. We used conditional Poisson regression to compare each patient's incidence rate of the outcome during 3 sequential risk periods (1-7, 8-14, and 15-28 days after asthma exacerbation) with that of the reference period (ie, summed period before and after the 3 risk periods).
We identified 4607 adults hospitalized for asthma exacerbation who had a first episode of acute myocardial infarction or ischemic stroke. During the reference period, the incidence rate of acute myocardial infarction or ischemic stroke was 25.0/100 person-years. Compared with the reference period, the incidence rate significantly increased during the first risk period (129.1/100 person-years), with a corresponding adjusted incidence rate ratio of 5.04 (95% CI, 4.29-5.88; P < .001). In the 2 subsequent risk periods, the incidence rate declined but remained high-50.1/100 person-years (adjusted incidence rate ratio, 1.96; 95% CI, 1.51-2.48; P < .001) and 38.0/100 person-years (adjusted incidence rate ratio, 1.48; 95% CI, 1.20-1.81; P < .001), respectively. The findings were similar when the 2 outcomes were examined separately.
In this population-based study of adults with asthma, the risk of acute myocardial infarction and ischemic stroke increased significantly after asthma exacerbation.
哮喘患者急性心肌梗死和缺血性中风的发病率较高。
研究哮喘急性加重对这些心血管事件的急性影响。
利用2011年至2014年期间美国3个地理位置不同的州（佛罗里达州、内布拉斯加州和纽约州）基于人群的住院患者数据，我们对因哮喘急性加重住院的成年人（年龄≥40岁）进行了一项自身对照病例系列研究。主要结局是急性心肌梗死和缺血性中风的复合结局。我们使用条件泊松回归比较每位患者在3个连续风险期（哮喘急性加重后1 - 7天、8 - 14天和15 - 28天）的结局发生率与参考期（即3个风险期之前和之后的总和期）的结局发生率。
我们确定了4607名因哮喘急性加重住院且首次发生急性心肌梗死或缺血性中风的成年人。在参考期内，急性心肌梗死或缺血性中风的发生率为25.0/100人年。与参考期相比，第一个风险期的发生率显著增加（129.1/100人年），相应的调整后发生率比为5.04（95%CI，4.29 - 5.88；P <.001）。在随后的2个风险期，发生率下降但仍保持较高水平——分别为50.1/100人年（调整后发生率比，1.96；95%CI，1.51 - 2.48；P <.001）和38.0/100人年（调整后发生率比，1.48；95%CI，1.20 - 1.81；P <.001）。分别检查这2个结局时，结果相似。
在这项基于人群的哮喘成年患者研究中，哮喘急性加重后急性心肌梗死和缺血性中风的风险显著增加。
