美国密歇根州经皮冠状动脉介入治疗后大麻使用与院内结局
Marijuana Use and In-Hospital Outcomes After Percutaneous Coronary Intervention in Michigan, United States.
机构信息
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
JACC Cardiovasc Interv. 2021 Aug 23;14(16):1757-1767. doi: 10.1016/j.jcin.2021.06.036.
OBJECTIVES
The aim of this study was to evaluate the association between reported marijuana use and post-percutaneous coronary intervention (PCI) in-hospital outcomes.
BACKGROUND
Marijuana use is increasing as more states in the United States legalize its use for recreational and medicinal purposes. Little is known about the frequency of use and relative safety of marijuana among patients presenting for PCI.
METHODS
The authors analyzed Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry data between January 1, 2013, and September 30, 2016. One-to-one propensity matching and multivariable logistic regression were used to adjust for differences between patients with or without reported marijuana use, and rates of post-PCI complications were compared.
RESULTS
Among 113,477 patients, 3,970 reported marijuana use. Compared with those without reported marijuana use, patients with reported marijuana use were likely to be younger (53.9 years vs 65.8 years), to use tobacco (73.0% vs 26.8%), to present with ST-segment elevation myocardial infarction (27.3% vs 15.9%), and to have fewer cardiovascular comorbidities. After matching, compared with patients without reported marijuana use, those with reported marijuana use experienced significantly higher risks for bleeding (adjusted odds ratio [aOR]: 1.54; 95% confidence interval [CI]: 1.20-1.97; P < 0.001) and cerebrovascular accident (aOR: 11.01; 95% CI: 1.32-91.67; P = 0.026) and a lower risk for acute kidney injury (aOR: 0.61; 95% CI: 0.42-0.87; P = 0.007). There were no significant differences in risks for transfusion and death.
CONCLUSIONS
A modest fraction of patients undergoing PCI used marijuana. Reported marijuana use was associated with higher risks for cerebrovascular accident and bleeding and a lower risk for acute kidney injury after PCI. Clinicians and patients should be aware of the higher risk for post-PCI complications in these patients.
目的
本研究旨在评估报告的大麻使用与经皮冠状动脉介入治疗（PCI）后院内结局之间的关联。
背景
随着美国越来越多的州将大麻的使用合法化用于娱乐和医疗目的，大麻的使用量正在增加。目前尚不清楚在接受 PCI 的患者中，大麻的使用频率和相对安全性。
方法
作者分析了 2013 年 1 月 1 日至 2016 年 9 月 30 日期间密歇根州蓝十字蓝盾心血管联合会 PCI 登记处的数据。采用一对一倾向评分匹配和多变量逻辑回归来调整报告的大麻使用患者与未报告大麻使用患者之间的差异，并比较了 PCI 后并发症的发生率。
结果
在 113477 名患者中，有 3970 名报告了大麻使用。与未报告大麻使用的患者相比，报告有大麻使用的患者更年轻（53.9 岁 vs 65.8 岁），使用烟草（73.0% vs 26.8%），出现 ST 段抬高型心肌梗死（27.3% vs 15.9%），心血管合并症较少。匹配后，与未报告大麻使用的患者相比，报告有大麻使用的患者发生出血的风险显著更高（校正比值比[aOR]：1.54；95%置信区间[CI]：1.20-1.97；P<0.001）和发生脑血管意外的风险更高（aOR：11.01；95%CI：1.32-91.67；P=0.026），发生急性肾损伤的风险更低（aOR：0.61；95%CI：0.42-0.87；P=0.007）。输血和死亡的风险无显著差异。
结论
接受 PCI 的患者中，有一小部分使用过大麻。报告的大麻使用与 PCI 后脑血管意外和出血的风险增加以及急性肾损伤的风险降低相关。临床医生和患者应意识到这些患者发生 PCI 后并发症的风险更高。
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