Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
J Cardiothorac Surg. 2022 Apr 27;17(1):84. doi: 10.1186/s13019-022-01836-4.
Recent research suggests a protective role for positive family history of premature cardiovascular disease (FHpCVD) in patients undergoing coronary artery bypass grafting. We aimed to further investigate this unlikely association.
In this registry-based cohort study, patients who underwent first-time non-emergent coronary bypass surgery at Tehran Heart Center between 2007 and 2016 were included. Patients with and without FHpCVD were compared in terms of all-cause mortality and first non-fatal cardiovascular events (CVEs) comprising non-fatal acute coronary syndrome, non-fatal stroke or transient ischemic attack, and repeat coronary revascularization.
A total of 13,156 patients were included (mean age 60.83 ± 9.57, 74.5% male), among which 2684 (20.4%) patients had FHpCVD. Median follow-up was 77.7 months. FHpCVD was weakly associated with reduced all-cause mortality using inverse probability weight (IPW) method (hazard ratio [HR] = 0.853; 95% confidence interval [CI] 0.730-0.997; P = 0.046), and not associated with non-fatal CVEs considering death as the competing event (sub-distribution HR [SHR] = 1.124; 95% CI 0.999-1.265; P = 0.053). Within a subgroup of patients without previous myocardial infarction or revascularization (7403 cases; 56.3%), FHpCVD was associated with lower mortality (HR = 0.700; 95% CI 0.548-0.894; P = 0.004) and higher non-fatal CVEs (SHR = 1.197; 95% CI 1.019-1.405; P = 0.028), whereas among patients with previous coronary events, there was no association between FHpCVD and outcomes.
FHpCVD was associated with lower all-cause mortality but higher non-fatal CVEs, especially in those without prior coronary events. Such discordance calls for caution in assuming a protective role for FHpCVD. The prognostic significance of FHpCVD needs further evaluation among surgical patients.
最近的研究表明，阳性家族史与早发性心血管疾病（FHpCVD）与接受冠状动脉旁路移植术的患者具有保护作用。我们旨在进一步研究这种不太可能的关联。
本研究为基于注册的队列研究，纳入了 2007 年至 2016 年期间在德黑兰心脏中心首次接受非紧急冠状动脉旁路手术的患者。比较了有和无 FHpCVD 的患者的全因死亡率和首次非致命性心血管事件（CVEs），包括非致命性急性冠状动脉综合征、非致命性卒中和短暂性脑缺血发作，以及再次冠状动脉血运重建。
共纳入 13156 例患者（平均年龄 60.83±9.57 岁，74.5%为男性），其中 2684 例（20.4%）患者有 FHpCVD。中位随访时间为 77.7 个月。使用逆概率加权（IPW）方法，FHpCVD 与全因死亡率降低呈弱相关（风险比 [HR] = 0.853；95%置信区间 [CI] 0.730-0.997；P = 0.046），而考虑死亡为竞争事件时，与非致命性 CVEs 无关（亚分布 HR [SHR] = 1.124；95%CI 0.999-1.265；P = 0.053）。在无先前心肌梗死或血运重建的患者亚组（7403 例，56.3%）中，FHpCVD 与死亡率降低相关（HR = 0.700；95%CI 0.548-0.894；P = 0.004）和非致命性 CVEs 升高相关（SHR = 1.197；95%CI 1.019-1.405；P = 0.028），而在有先前冠状动脉事件的患者中，FHpCVD 与结局之间无关联。
FHpCVD 与全因死亡率降低相关，但与非致命性 CVEs 升高相关，尤其是在无先前冠状动脉事件的患者中。这种不一致性表明，对于 FHpCVD 的保护作用，应谨慎假设。FHpCVD 的预后意义仍需在手术患者中进一步评估。
