Muncan Brandon, Abboud Alan, Papamanoli Aikaterini, Jacobs Mark, McLarty Allison J, Skopicki Hal A, Kalogeropoulos Andreas P
Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA.
Department of Medicine, Zucker School of Medicine, Northwell Health at Mather Hospital, Port Jefferson, NY 11777, USA.
J Pers Med. 2022 Sep 22;12(10):1562. doi: 10.3390/jpm12101562.
Background: Disparities in treatment and outcomes of infective endocarditis (IE) between people who use drugs (PWUD) and non-PWUD have been reported, but long-term data on cardiovascular and cerebrovascular outcomes are limited. We aim to compare 5-year rates of mortality, cardiovascular and cerebrovascular events after IE between PWUD and non-PWUD. Methods: Using data from the TriNetX Research Network, we examined 5-year cumulative incidence of mortality, myocardial infarction, heart failure, atrial fibrillation/flutter, ventricular tachyarrhythmias, ischemic stroke, and intracranial hemorrhage in 7132 PWUD and 7132 propensity score-matched non-PWUD patients after a first episode of IE. We used the Kaplan−Meier estimate for incidence and Cox proportional hazards models to estimate relative risk. Results: Matched PWUD were 41 ± 12 years old; 52.2% men; 70.4% White, 19.8% Black, and 8.0% Hispanic. PWUD had higher mortality vs. non-PWUD after 1 year (1−3 year: 9.2% vs. 7.5%, p = 0.032; and 3−5-year: 7.3% vs. 5.1%, p = 0.020), which was largely driven by higher mortality among female patients. PWUD also had higher rates of myocardial infarction (10.0% vs. 7.0%, p < 0.001), heart failure (19.3% vs. 15.2%, p = 0.002), ischemic stroke (8.3% vs. 6.3%, p = 0.001), and intracranial hemorrhage (4.1% vs. 2.8%, p = 0.009) compared to non-PWUD. Among surgically treated PWUD, interventions on the tricuspid valve were more common; however, rates of all outcomes were comparable to non-PWUD. Conclusions: PWUD had higher 5-year incidence of cardiovascular and cerebrovascular events after IE compared to non-PWUD patients. Prospective investigation into the causes of these disparities and potential harm reduction efforts are needed.
有报告称，吸毒者（PWUD）与非吸毒者在感染性心内膜炎（IE）的治疗及预后方面存在差异，但关于心血管和脑血管预后的长期数据有限。我们旨在比较PWUD与非吸毒者发生IE后5年的死亡率、心血管和脑血管事件发生率。方法：利用TriNetX研究网络的数据，我们调查了7132例PWUD患者和7132例倾向评分匹配的非PWUD患者在首次发生IE后5年的死亡率、心肌梗死、心力衰竭、心房颤动/扑动、室性快速心律失常、缺血性卒中及颅内出血的累积发生率。我们使用Kaplan-Meier估计法计算发生率，并使用Cox比例风险模型估计相对风险。结果：匹配的PWUD患者年龄为41±12岁；男性占52.2%；白人占70.4%，黑人占19.8%，西班牙裔占8.0%。PWUD患者在1年后的死亡率高于非PWUD患者（1 - 3年：9.2%对7.5%，p = 0.032；3 - 5年：7.3%对5.1%，p = 0.020），这在很大程度上是由女性患者较高的死亡率驱动的。与非PWUD患者相比，PWUD患者的心肌梗死发生率（10.0%对7.0%，p < 0.001）、心力衰竭发生率（19.3%对15.2%，p = 0.002）、缺血性卒中发生率（8.3%对6.3%，p = 0.001）和颅内出血发生率（4.1%对2.8%，p = 0.009）也更高。在接受手术治疗的PWUD患者中，三尖瓣干预更为常见；然而，所有结局的发生率与非PWUD患者相当。结论：与非PWUD患者相比，PWUD患者发生IE后5年的心血管和脑血管事件发生率更高。需要对这些差异的原因进行前瞻性调查，并努力减少潜在危害。
