Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
J Am Coll Cardiol. 2021 Apr 20;77(15):1875-1887. doi: 10.1016/j.jacc.2021.02.047.
Recent population-based studies have revealed that the use of fluoroquinolones (FQs) is associated with an increased risk of aortic dissection (AD) and aneurysm (AA). However, no evidence is available on whether FQs increase adverse events in patients who had been diagnosed with AD or AA.
This study investigated whether the use of FQs increases the risk of aortic-related adverse events and death in this high-risk population.
A retrospective cohort study was conducted by using the Taiwan National Health Insurance Research Database. A total of 31,570 adult patients who survived after admission for AD or AA between 2001 and 2013 were identified. We divided each calendar year into 6 data units (2 months) for each patient and each year during follow-up. Covariates and exposure of interest (FQs) were reassessed every 2 months. We used another common antibiotic, amoxicillin, as a negative control exposure.
Exposure to FQs was associated with a higher risk of all-cause death (adjusted hazard ratio: 1.61; 95% confidence interval: 1.50 to 1.73), aortic death (adjusted hazard ratio: 1.80; 95% confidence interval: 1.50 to 2.15), and later aortic surgery. However, amoxicillin exposure was not significantly associated with risk of any of the outcomes. A subgroup analysis revealed that the effect of FQs was not significantly different between the AD and AA groups.
Relative to amoxicillin use, FQ exposure in patients with AD or AA was associated with a higher risk of adverse outcomes. FQs should not be used by high-risk patients unless no other treatment options are available.
最近的基于人群的研究表明，氟喹诺酮类药物（FQs）的使用与主动脉夹层（AD）和动脉瘤（AA）的风险增加有关。然而，尚无证据表明 FQs 是否会增加已诊断为 AD 或 AA 的患者的不良事件。
本研究旨在调查 FQs 是否会增加高危人群中与主动脉相关的不良事件和死亡的风险。
使用台湾全民健康保险研究数据库进行回顾性队列研究。共确定了 31570 名在 2001 年至 2013 年间因 AD 或 AA 住院后存活的成年患者。我们将每个日历年度分为每个患者的 6 个数据单位（2 个月），并在随访期间的每个年份进行随访。每 2 个月重新评估协变量和感兴趣的暴露（FQs）。我们使用另一种常见的抗生素阿莫西林作为阴性对照暴露。
FQs 的暴露与全因死亡（调整后的危险比：1.61；95%置信区间：1.50 至 1.73）、主动脉死亡（调整后的危险比：1.80；95%置信区间：1.50 至 2.15）和随后的主动脉手术风险增加相关。然而，阿莫西林暴露与任何结果的风险均无显著相关性。亚组分析显示，FQs 的作用在 AD 和 AA 组之间没有显著差异。
与阿莫西林使用相比，AD 或 AA 患者中 FQ 的暴露与不良结局的风险增加相关。除非没有其他治疗选择，否则高危患者不应使用 FQs。
