药物对急性心肌梗死合并慢性阻塞性肺疾病患者预后的影响：一项全国性队列研究。
Impact of medications on outcomes in patients with acute myocardial infarction and chronic obstructive pulmonary disease: A nationwide cohort study.
作者信息
Chiang Cheng-Hung, Jiang You-Cheng, Hung Wan-Ting, Kuo Shu-Hung, Hsia Kai, Wang Chia-Lin, Fu Yun-Ju, Lin Kun-Chang, Lin Su-Chiang, Cheng Chin-Chang, Huang Wei-Chun
机构信息
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2023 Feb 1;86(2):183-190. doi: 10.1097/JCMA.0000000000000835. Epub 2022 Oct 28.
BACKGROUND
Various inhaled bronchodilators have been associated with cardiovascular safety concerns. This study aimed to investigate the long-term impact of chronic obstructive pulmonary disease (COPD) and the safety of COPD medications in patients after their first acute myocardial infarction (AMI).
METHODS
This nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Patients hospitalized between 2000 and 2012 with a primary diagnosis of first AMI were included and divided into three cohorts (AMI, ST-elevation myocardial infarction [STEMI], and non-STEMI [NSTEMI]). Each cohort was propensity score matched (1:1) with patients without COPD. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) with 95% CIs.
RESULTS
A total of 186 112 patients with AMI were enrolled, and COPD was diagnosed in 13 065 (7%) patients. Kaplan-Meier curves showed that patients with COPD had a higher mortality risk than those without COPD in all cohorts (AMI, STEMI, and NSTEMI). The HR of mortality in AMI, STEMI, and NSTEMI patients with COPD was 1.12 (95% CI, 1.09-1.14), 1.20 (95% CI, 1.14-1.25), and 1.07 (95% CI, 1.04-1.10), respectively. Short-acting inhaled bronchodilators and corticosteroids increased mortality risk in all three cohorts. However, long-acting inhaled bronchodilators reduced mortality risk in patients with AMI (long-acting beta-agonist [LABA]: HR, 0.87; 95% CI, 0.81-0.94; long-acting muscarinic antagonist [LAMA]: HR, 0.82; 95% CI, 0.69-0.96) and NSTEMI (LABA: HR, 0.89; 95% CI, 0.83-0.97; LAMA: HR, 0.80; 95% CI, 0.68-0.96).
CONCLUSION
This study demonstrated that AMI patients with COPD had higher mortality rates than those without COPD. Using inhaled short-acting bronchodilators and corticosteroids reduced survival, whereas long-acting bronchodilators provided survival benefits in AMI and NSTEMI patients. Therefore, appropriate COPD medication for acute AMI is crucial.
背景
多种吸入性支气管扩张剂已引发心血管安全性问题。本研究旨在调查慢性阻塞性肺疾病（COPD）的长期影响以及COPD药物在首次急性心肌梗死（AMI）患者中的安全性。
方法
本全国性队列研究使用了台湾国民健康保险研究数据库的数据。纳入2000年至2012年间因首次AMI入院的患者，并分为三个队列（AMI、ST段抬高型心肌梗死[STEMI]和非ST段抬高型心肌梗死[NSTEMI]）。每个队列与无COPD的患者进行倾向评分匹配（1:1）。采用Cox比例风险回归模型估计风险比（HR）及95%置信区间（CI）。
结果
共纳入186112例AMI患者，其中13065例（7%）被诊断为COPD。Kaplan-Meier曲线显示，在所有队列（AMI、STEMI和NSTEMI）中，COPD患者的死亡风险均高于无COPD的患者。AMI、STEMI和NSTEMI合并COPD患者死亡的HR分别为1.12（95%CI，1.09 - 1.14）、1.20（95%CI，1.14 - 1.25）和1.07（95%CI，1.04 - 1.10）。短效吸入性支气管扩张剂和皮质类固醇在所有三个队列中均增加了死亡风险。然而，长效吸入性支气管扩张剂降低了AMI患者（长效β受体激动剂[LABA]：HR，0.87；95%CI，0.81 - 0.94；长效毒蕈碱拮抗剂[LAMA]：HR，0.82；95%CI，0.69 - 0.96）和NSTEMI患者（LABA：HR，0.89；95%CI，0.83 - 0.97；LAMA：HR，0.80；95%CI，0.
Zotero 插件