Kallio Mika, Korkeila Jyrki, Malmberg Markus, Gunn Jarmo, Rautava Päivi, Korhonen Päivi, Kytö Ville
Department of Psychiatry, University of Turku and Turku University Hospital, Finland.
Department of Psychiatry, University of Turku and Turku University Hospital, Finland; and Department of Psychiatry, Hospital District of Satakunta, Finland.
BJPsych Open. 2022 Feb 11;8(2):e48. doi: 10.1192/bjo.2022.10.
Patients with schizophrenia spectrum disorder have increased risk of coronary artery disease.
To investigate long-term outcomes of patients with schizophrenia spectrum disorder and coronary artery disease after coronary artery bypass grafting surgery (CABG).
Data from patients with schizophrenia spectrum disorder (n = 126) were retrospectively compared with propensity-matched (1:20) control patients without schizophrenia spectrum disorder (n = 2520) in a multicentre study in Finland. All patients were treated with CABG. The median follow-up was 7.1 years. The primary outcome was all-cause mortality.
Patients with diagnosed schizophrenia spectrum disorder had an elevated risk of 10-year mortality after CABG, compared with control patients (42.7 v. 30.3%; hazard ratio 1.56; 95% CI 1.13-2.17; P = 0.008). Schizophrenia spectrum diagnosis was associated with a higher risk of major adverse cardiovascular events during follow-up (49.9 v. 32.6%, subdistribution hazard ratio 1.59; 95% CI 1.18-2.15; P = 0.003). Myocardial infarction (subdistribution hazard ratio 1.86; P = 0.003) and cardiovascular mortality (subdistribution hazard ratio 1.65; P = 0.017) were more frequent in patients with versus those without schizophrenia spectrum disorder, but there was no difference for stroke. Psychiatric ward admission, antipsychotic medication, antidepressant use and benzodiazepine use before CABG were not associated with outcome differences. After CABG, patients with schizophrenia spectrum disorder received statin therapy less often and had lower doses; the use of other cardiovascular medications was similar between schizophrenia spectrum and control groups.
Patients with schizophrenia spectrum disorder have higher long-term risks of death and major adverse cardiovascular events after CABG. The results underline the vulnerability of these patients and highlight the importance of intensive secondary prevention and risk factor optimisation.
精神分裂症谱系障碍患者患冠状动脉疾病的风险增加。
研究冠状动脉搭桥手术（CABG）后精神分裂症谱系障碍合并冠状动脉疾病患者的长期预后。
在芬兰的一项多中心研究中，对126例精神分裂症谱系障碍患者的数据与倾向匹配（1:20）的无精神分裂症谱系障碍对照患者（2520例）进行回顾性比较。所有患者均接受CABG治疗。中位随访时间为7.1年。主要结局为全因死亡率。
与对照患者相比，确诊为精神分裂症谱系障碍的患者在CABG后10年死亡风险升高（42.7%对30.3%；风险比1.56；95%CI 1.13 - 2.17；P = 0.008）。精神分裂症谱系诊断与随访期间主要不良心血管事件的较高风险相关（49.9%对32.6%，亚分布风险比1.59；95%CI 1.18 - 2.15；P = 0.003）。与无精神分裂症谱系障碍的患者相比，精神分裂症谱系障碍患者发生心肌梗死（亚分布风险比1.86；P = 0.003）和心血管死亡（亚分布风险比1.65；P = 0.017）更为频繁，但中风方面无差异。CABG前的精神科病房住院、抗精神病药物使用、抗抑郁药使用和苯二氮䓬类药物使用与结局差异无关。CABG后，精神分裂症谱系障碍患者接受他汀类药物治疗的频率较低且剂量较低；精神分裂症谱系组和对照组在其他心血管药物的使用方面相似。
精神分裂症谱系障碍患者在CABG后有更高的长期死亡风险和主要不良心血管事件风险。结果强调了这些患者的脆弱性，并突出了强化二级预防和优化危险因素的重要性。
