Edigin Ehizogie, Shaka Hafeez, Eseaton Precious, Jamal Shakeel, Kichloo Asim, Ojemolon Pius E, Asemota Iriagbonse, Akuna Emmanuel, Manadan Augustine
Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA.
Internal Medicine, University of Benin, Benin City, NGA.
Cureus. 2020 Aug 17;12(8):e9799. doi: 10.7759/cureus.9799.
This study aims to compare the outcomes of patients admitted primarily for acute coronary syndrome (ACS) with and without a secondary diagnosis of rheumatoid arthritis (RA).
Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations of adult patients with ACS as principal diagnoses, with and without RA as a secondary diagnosis. The primary outcome was inpatient mortality. Secondary outcomes were hospitalization characteristics and cardiovascular therapies. Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders.
There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Out of 1.3 million patients with ACS, 22,615 (1.7%) had RA. RA group was older (70.4 vs 66.8 years, P<0.001) as compared to the non-RA group, and had more females (63.7% vs 37.7%, P<0.0001). Patients with RA had a 16% reduced risk of in-hospital mortality: odds ratio (OR) 0.84, 95% confidence interval (CI) (0.72-0.99), P=0.034; less odds of undergoing intra-aortic balloon pump (IABP): OR 0.78, 95% CI (0.64-0.95), P=0.015; and 0.18 days shorter hospital length of stay (LOS): 95% CI (0.32-0.05), P=0.009. However, odds of undergoing percutaneous coronary intervention with drug-eluting stent (PCI DES) at OR 1.14, 95% CI (1.07-1.23), P<0.0001 was significantly higher in the RA group compared to ACS without RA.
Patients admitted for ACS with co-existing RA had lower adjusted inpatient mortality, less odds of undergoing IABP, shorter adjusted LOS, and greater adjusted odds of undergoing PCI DES compared to those without RA.
本研究旨在比较主要因急性冠状动脉综合征(ACS)入院且伴有或不伴有类风湿关节炎(RA)二级诊断的患者的治疗结果。
数据取自2016年和2017年国家住院患者样本(NIS)数据库。在NIS中搜索以ACS作为主要诊断的成年患者的住院情况,这些患者伴有或不伴有RA作为二级诊断。主要结局是住院死亡率。次要结局是住院特征和心血管治疗。相应地使用多变量逻辑回归和线性回归分析来调整混杂因素。
2016年和2017年合并的NIS数据库中包括超过7100万例出院病例。在130万例ACS患者中,22615例(1.7%)患有RA。与非RA组相比,RA组年龄更大(70.4岁对66.8岁,P<0.001),女性更多(63.7%对37.7%,P<0.0001)。患有RA的患者住院死亡率风险降低16%:比值比(OR)为0.84,95%置信区间(CI)为(0.72 - 0.99),P = 0.034;接受主动脉内球囊反搏(IABP)的几率更低:OR为0.78,95%CI为(0.64 - 0.95),P = 0.015;住院时间缩短0.18天:95%CI为(0.32 - 0.05),P = 0.009。然而,与无RA的ACS患者相比,RA组接受药物洗脱支架经皮冠状动脉介入治疗(PCI DES)的几率显著更高,OR为1.14,95%CI为(1.07 - 1.23),P<0.0001。
与无RA的患者相比,因ACS入院且合并RA的患者调整后的住院死亡率更低,接受IABP的几率更低,调整后的住院时间更短,接受PCI DES的调整几率更高。