Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston.
Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
Am J Med. 2021 Aug;134(8):992-1001.e4. doi: 10.1016/j.amjmed.2021.03.013. Epub 2021 Apr 16.
There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia.
We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia.
The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64).
In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.
目前关于家族性高胆固醇血症患者急性心肌梗死结局的数据较为匮乏。
我们查询了 2016 年至 2018 年全国再入院数据库中与急性心肌梗死相关的住院数据。采用多变量回归分析比较了有和无家族性高胆固醇血症患者的住院期间结局和 30 天再入院率。
该分析共纳入了 1363488 例急性心肌梗死住院患者。家族性高胆固醇血症在急性心肌梗死入院患者中的患病率为 0.07%。与无家族性高胆固醇血症的患者相比，有家族性高胆固醇血症的患者更年轻，合并症更少，但更有可能发生过梗死和血运重建。有家族性高胆固醇血症的患者更可能出现 ST 段抬高型心肌梗死并接受血运重建。多变量调整后，高胆固醇血症患者与无高胆固醇血症患者的院内病死率无差异（校正比值比 [aOR] 0.76；95%置信区间 [CI] 0.41-1.39）。有急性心肌梗死和家族性高胆固醇血症的患者发生心脏骤停和使用机械支持的校正比例较高。两组患者的总体 30 天再入院率（aOR 0.75；95%CI 0.51-1.10）或 30 天急性心肌梗死再入院率无差异。然而，家族性高胆固醇血症患者接受经皮冠状动脉介入治疗的再入院率有升高趋势，但无统计学意义（aOR 1.89；95%CI 0.98-3.64）。
在这项当代全国性观察性分析中，家族性高胆固醇血症患者占急性心肌梗死患者总数的一小部分，具有独特的临床特征，但与无家族性高胆固醇血症患者相比，院内病死率似乎没有更高。
