Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China.
Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Clin Ther. 2022 Oct;44(10):1370-1379. doi: 10.1016/j.clinthera.2022.08.011. Epub 2022 Sep 21.
The underlying ischemic and bleeding risks of acute myocardial infarction (AMI) with active tuberculosis (TB) are unknown. The goal of this study was to explore the ischemic and bleeding risks, as well as treatment strategies during hospitalization, in patients with AMI with or without active TB.
Patients were recruited from a tuberculosis hospital from 2014 to 2021. The primary outcomes were major cardiovascular and cerebrovascular events (MACE) and Bleeding Academic Research Consortium (BARC)-defined type 3 or 5 bleeding. Multivariate logistic regression and propensity score matching were performed for risk adjustment. Subgroups were defined according to AMI with active pulmonary TB and AMI with active TB undergoing percutaneous coronary intervention (PCI).
A total of 242 patients were enrolled. Compared with AMI without active TB, AMI with active TB had a higher risk of MACE and BARC type 3 or 5 bleeding (P < 0.001 and P = 0.002, respectively). Multivariate logistic regression analysis showed that, compared with AMI without active TB, the odds ratio (OR) was 6.513 (95% CI, 2.195-19.331) for MACE in patients with AMI with active TB, and the OR was 16.074 (95% CI 3.337-77.436) for BARC type 3 or 5 bleeding in patients with AMI with active TB. After propensity score matching, AMI with active TB tended to increase the risk of MACE, although not statistically significantly (P = 0.189), and increased BARC type 3 or 5 bleeding (P < 0.001), compared with AMI without active TB. Results of subgroup analyses showed that active TB had outcomes consistent with those of the total cohort. AMI patients with active pulmonary TB who underwent PCI had a lower risk of MACE without an increase in the risk of bleeding compared with those not undergoing PCI.
Patients with AMI with active TB have a higher risk of MACE (or severe MACE) and bleeding than patients with AMI without active TB. However, AMI patients with active TB are still advised to undergo PCI for a high net clinical benefit.
急性心肌梗死（AMI）合并活动性肺结核（TB）的潜在缺血和出血风险尚不清楚。本研究旨在探讨 AMI 合并活动性 TB 与不合并活动性 TB 患者的缺血和出血风险，以及住院期间的治疗策略。
2014 年至 2021 年期间，我们从一家结核病医院招募了患者。主要结局是主要心血管和脑血管事件（MACE）和 Bleeding Academic Research Consortium（BARC）定义的 3 型或 5 型出血。采用多变量逻辑回归和倾向评分匹配进行风险调整。根据 AMI 合并活动性肺结核和 AMI 合并活动性肺结核行经皮冠状动脉介入治疗（PCI）进行亚组定义。
共纳入 242 例患者。与 AMI 不合并活动性 TB 相比，AMI 合并活动性 TB 患者的 MACE 和 BARC 3 型或 5 型出血风险更高（P<0.001 和 P=0.002）。多变量逻辑回归分析显示，与 AMI 不合并活动性 TB 相比，AMI 合并活动性 TB 患者的 MACE 比值比（OR）为 6.513（95%CI，2.195-19.331），AMI 合并活动性 TB 患者的 BARC 3 型或 5 型出血 OR 为 16.074（95%CI，3.337-77.436）。经过倾向评分匹配后，尽管差异无统计学意义（P=0.189），但 AMI 合并活动性 TB 仍倾向于增加 MACE 的风险，且增加了 BARC 3 型或 5 型出血（P<0.001）。亚组分析结果显示，活动性 TB 与全队列结果一致。与未行 PCI 的患者相比，行 PCI 的 AMI 合并活动性肺结核患者的 MACE 风险较低，且出血风险无增加。
与 AMI 不合并活动性 TB 相比，AMI 合并活动性 TB 患者的 MACE（或严重 MACE）和出血风险更高。然而，仍建议 AMI 合并活动性 TB 患者行 PCI 治疗以获得更高的净临床获益。
