Division of Vascular Surgery, Department of Surgery, McMaster University, Burlington, ON, Canada.
1857Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Vasc Endovascular Surg. 2022 Jul;56(5):480-494. doi: 10.1177/15385744221085382. Epub 2022 May 3.
Heavy cannabis use has been associated with the development of acute myocardial infarction and stroke. The objective of this study was to determine if heavy, chronic cannabis use is associated with the development of acute limb ischemia (ALI) or critical limb ischemia (CLI).
We conducted a retrospective cohort study within the National Inpatient Sample (2006-2015). Patients without cannabis use disorder (CUD) were matched to patients with CUD in a 2:1 ratio using propensity scores. Our primary outcomes were incidence of ALI and CLI. Secondary outcomes included incidence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), frequency of open or endovascular interventions, length of stay, and total costs. Sensitivity analyses were performed with alternative models, including in the entire unmatched cohort with regression models utilizing survey weights to account for sampling methodology.
We identified a cohort of 46,297 857 unmatched patients. Patients with CUD in the unmatched cohort were younger, with less cardiovascular risk factors, but higher rates of smoking and substance abuse. The matched cohort included 824,856 patients with CUD and 1,610,497 controls. Those with CUD had a higher incidence of ALI (OR 1.20 95% CI: 1.04-1.38 =.016). Following multiple sensitivity analyses, there was no robust association between CLI and CUD. We observed no robust association of CUD with AMI, CMI, procedures performed, frequency of amputation, costs, or total length of stay.
Cannabis use disorder was associated with a significantly higher incidence of admission for acute limb ischemia. CUD was not associated with an increased risk of critical limb ischemia following sensitivity analysis. Given CUD is often seen in younger, less co-morbid patients it provides an important target for intervention in this population.
重度大麻使用与急性心肌梗死和中风的发生有关。本研究的目的是确定重度、慢性大麻使用是否与急性肢体缺血（ALI）或严重肢体缺血（CLI）的发生有关。
我们在国家住院患者样本（2006-2015 年）中进行了一项回顾性队列研究。无大麻使用障碍（CUD）的患者与 CUD 患者按 2:1 的比例使用倾向评分匹配。我们的主要结局是 ALI 和 CLI 的发生率。次要结局包括急性肠系膜缺血（AMI）、慢性肠系膜缺血（CMI）的发生率、开放或血管内介入的频率、住院时间和总费用。采用替代模型进行敏感性分析，包括在整个未匹配队列中使用回归模型，利用调查权重来考虑抽样方法。
我们确定了一个 46297857 例未匹配患者的队列。未匹配队列中患有 CUD 的患者年龄较小，心血管危险因素较少，但吸烟和药物滥用的比例较高。匹配队列包括 824856 例患有 CUD 和 1610497 例对照者。患有 CUD 的患者发生 ALI 的发生率较高（OR 1.20，95%CI：1.04-1.38，P=.016）。经过多次敏感性分析，CUD 与 CLI 之间没有牢固的关联。我们没有观察到 CUD 与 AMI、CMI、进行的操作、截肢的频率、成本或总住院时间之间存在牢固的关联。
大麻使用障碍与急性肢体缺血入院的发生率显著增加有关。在敏感性分析后，CUD 与严重肢体缺血的风险增加无关。鉴于 CUD 通常发生在年轻、合并症较少的患者中，这为该人群的干预提供了一个重要目标。
