Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN.
K.G. Jebsen - Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.
J Am Heart Assoc. 2022 Jul 19;11(14):e024358. doi: 10.1161/JAHA.121.024358. Epub 2022 Jul 15.
Background Pulmonary hypertension (PH) is a devastating potential complication of pulmonary embolism, a manifestation of venous thromboembolism (VTE). The incidence of and risk factors for PH in those with prior VTE are poorly characterized. Methods and Results () codes from inpatient and outpatient medical claims from MarketScan administrative databases for years 2011 to 2018 were used to identify cases of VTE, comorbidities before the VTE event, and PH occurring subsequent to the VTE event. Cumulative incidence and hazard ratios (HR), and their 95% CI, were calculated. The 170 021 VTE cases included in the analysis were on average (±SD) 57.5±15.8 years old and 50.5% were female. A total of 5943 PH cases accrued over an average follow-up of 1.94 years. Two years after incident VTE, the cumulative incidence (95% CI) of PH was 3.5% (3.4%-3.7%) overall. It was higher among older individuals, among women (3.9% [3.8%-4.1%]) than men (3.2% [3.0%-3.3%]), and among patients presenting with pulmonary embolism (6.2% [6.0%-6.5%]) than those presenting with deep vein thrombosis only (1.1% [1.0%-1.2%]). Adjusting for age and sex, risk of PH was higher among patients with VTE with underlying comorbidities. Using the Charlson comorbidity index, there was a dose-response relationship, whereby greater scores were associated with increased PH risk (score ≥5 versus 0: HR, (2.50 [2.30-2.71])). When evaluating individual comorbidities, the strongest associations were observed with concomitant heart failure (HR, 2.17 [2.04-2.31]), chronic pulmonary disease (2.01 [1.90-2.14]), and alcohol abuse (1.66 [1.29-2.13]). Conclusions In this large, real-world population of insured people with VTE, 3.5% developed PH in the 2 years following their initial VTE event. Risk was higher among women, with increasing age, and in those with additional comorbidities at the time of the VTE event. These data provide insights into the burden of PH and risk factors for PH among patients with VTE.
背景 肺动脉高压（PH）是肺栓塞的一种潜在的毁灭性并发症，是静脉血栓栓塞症（VTE）的一种表现。先前患有 VTE 的患者发生 PH 的发生率和危险因素尚未得到充分描述。
方法和结果 利用 MarketScan 管理数据库 2011 年至 2018 年的住院和门诊医疗索赔（）代码，确定 VTE 病例、VTE 事件前的合并症以及 VTE 事件后发生的 PH。计算累积发生率和风险比（HR）及其 95%CI。分析中纳入了 170021 例 VTE 患者，平均（±SD）年龄为 57.5±15.8 岁，50.5%为女性。平均随访 1.94 年后共发生了 5943 例 PH 病例。在 VTE 事件发生后 2 年内，PH 的累积发生率（95%CI）总体为 3.5%（3.4%-3.7%）。年龄较大、女性（3.9%[3.8%-4.1%]）高于男性（3.2%[3.0%-3.3%]），肺栓塞（6.2%[6.0%-6.5%]）患者高于单纯深静脉血栓形成（1.1%[1.0%-1.2%]）患者。调整年龄和性别后，VTE 患者合并基础合并症时，发生 PH 的风险更高。使用 Charlson 合并症指数，发现风险与评分呈剂量反应关系，即评分越高，PH 风险越高（评分≥5 与 0 相比：HR，（2.50[2.30-2.71]））。评估个体合并症时，最强的关联是心力衰竭（HR，2.17[2.04-2.31]）、慢性肺部疾病（2.01[1.90-2.14]）和酒精滥用（1.66[1.29-2.13]）。
结论 在这项针对有保险的 VTE 患者的大型真实世界人群研究中，3.5%的患者在首次 VTE 事件后 2 年内发生 PH。女性、年龄增长以及 VTE 时存在其他合并症的患者发生 PH 的风险更高。这些数据提供了 VTE 患者 PH 的负担和 PH 危险因素的见解。
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