Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel.
Healthcare Quality Indicators Program for Clalit Health Services Hospitals, Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv; Sial Research Center, Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Br J Gen Pract. 2021 Jan 28;71(703):e128-e133. doi: 10.3399/bjgp20X713945. Print 2021.
Corticosteroid injections (CSIs) are a common treatment for arthritis and other musculoskeletal conditions.
To determine whether there is an increased incidence of acute coronary syndrome (ACS) following intra-articular and soft-tissue CSI.
Cohort study in an urban primary care orthopaedic clinic.
Data were reviewed from all patients aged ≥50 years and seen by orthopaedic specialists between April 2012 and December 2015, including CSI, hospital admission in the week following the orthopaedic visit, and cardiovascular risk factors. The incidence of an ACS-associated hospital admission was compared between visits in which patients received CSIs and visits in which patients did not.
A total of 60 856 orthopaedic visits were reviewed (22 131 individual patients). The mean age was 70.9 years (standard deviation [SD] = 10.8), and 66.5% were female. Injections were administered in 3068 visits (5.1%). In the week following the visit there were 25 ACS hospital admissions (41 per 100 000 visits); seven events were after visits with an injection, and 18 were after non-injection visits. Patients who had received an injection were more likely to experience a subsequent ACS. (227 versus 31 events per 100 000 visits, odds ratio [OR] = 7.3; 95% confidence interval [CI] = 2.8 to 19.1). The association between receiving a CSI and ACS remained similar when the analysis was restricted to subgroups defined by age, sex, and cardiovascular risk factors.
CSI for musculoskeletal conditions may substantially increase the risk of ACS in the week following the injection. Although the absolute risk of ACS is small, the effect size appears to be clinically significant.
皮质类固醇注射（CSIs）是治疗关节炎和其他肌肉骨骼疾病的常用方法。
确定关节内和软组织 CSI 后急性冠状动脉综合征（ACS）的发生率是否增加。
在城市初级保健骨科诊所进行的队列研究。
回顾 2012 年 4 月至 2015 年 12 月期间所有年龄≥50 岁并由骨科专家就诊的患者的数据，包括 CSI、骨科就诊后一周内的住院治疗以及心血管危险因素。比较接受 CSI 就诊和未接受 CSI 就诊的患者 ACS 相关住院就诊的发生率。
共回顾了 60856 次骨科就诊（22131 名患者）。平均年龄为 70.9 岁（标准差[SD] = 10.8），66.5%为女性。在 3068 次就诊中进行了注射（5.1%）。在就诊后的一周内，有 25 例 ACS 住院治疗（41/100000 就诊）；7 例事件发生在就诊后进行注射，18 例发生在非注射就诊后。接受注射的患者更有可能随后发生 ACS。（227 例与 31 例事件/100000 就诊，比值比[OR] = 7.3；95%置信区间[CI] = 2.8 至 19.1）。当分析仅限于按年龄、性别和心血管危险因素定义的亚组时，接受 CSI 和 ACS 之间的关联仍然相似。
用于肌肉骨骼疾病的 CSI 可能会大大增加注射后一周内 ACS 的风险。尽管 ACS 的绝对风险很小，但效果大小似乎具有临床意义。
