Clalit Health Services, Tel Aviv, Israel.
Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel.
Fam Pract. 2023 Nov 23;40(4):552-559. doi: 10.1093/fampra/cmad080.
Musculoskeletal corticosteroid injection (CSI) is a frequently used treatment, considered safe with a low incidence of minor side effects.
To investigate whether the incidence of acute coronary syndrome (ACS) is increased following corticosteroid injection for musculoskeletal conditions.
Data were reviewed from 41,276 patients aged over 40 years and hospitalised with ACS between January 2015 and December 2019. Each ACS case was allocated up to 10 control patients from their primary care clinic, matched for age and sex. The cases and controls were reviewed for orthopaedic or rheumatological consultation including a CSI procedure and occurring prior to the hospital admission date. The incidence of CSI was compared between the case and control groups.
Data from a total of 413,063 patients were reviewed, 41,276 ACS cases and 371,787 controls. The mean age was 68.1, standard deviation (SD) = 13.1, 69.4% male. In the week prior to their hospital admission, 118 ACS patients were treated with CSI compared with 495 patients in the control group; odds ratio (OR) = 1.95 (1.56-2.43). In total, 98% of CSI procedures were carried out by orthopaedic specialists. An association between ACS and prior CSI was strongest in the days immediately prior to hospitalisation: OR = 3.11 (2.10-4.61) for patients who were injected 1 day before ACS. The association between ACS and CSI declined with increasing time between injection and hospital admission: at 90 days OR = 1.08 (0.98-1.18). The association remained robust when cardiovascular risk factors, history of rheumatological disease, and other co-morbidity were taken into consideration.
Musculoskeletal corticosteroid injection appears to substantially increase the risk of acute coronary syndrome.
肌肉骨骼皮质类固醇注射（CSI）是一种常用的治疗方法，被认为安全，副作用发生率低。
研究肌肉骨骼疾病皮质类固醇注射后是否会增加急性冠状动脉综合征（ACS）的发病率。
对 2015 年 1 月至 2019 年 12 月期间因 ACS 住院的 41276 名年龄超过 40 岁的患者进行了数据回顾。每个 ACS 病例都从其初级保健诊所中分配了多达 10 名对照患者，年龄和性别匹配。对接受过骨科或风湿病学咨询（包括 CSI 程序）的病例和对照患者进行了回顾，这些程序发生在入院日期之前。比较了病例组和对照组的 CSI 发生率。
共回顾了 413063 名患者的数据，其中 41276 例 ACS 病例和 371787 例对照。平均年龄为 68.1 岁，标准差（SD）=13.1，男性占 69.4%。在入院前一周，118 例 ACS 患者接受了 CSI 治疗，而对照组中 495 例患者接受了 CSI 治疗；比值比（OR）=1.95（1.56-2.43）。总共，98%的 CSI 程序是由骨科专家进行的。ACS 与之前的 CSI 之间的关联在入院前几天最为强烈：入院前一天接受注射的患者的 OR=3.11（2.10-4.61）。ACS 与 CSI 之间的关联随着注射和入院之间的时间间隔增加而下降：90 天时 OR=1.08（0.98-1.18）。当考虑心血管危险因素、风湿病病史和其他合并症时，该关联仍然可靠。
肌肉骨骼皮质类固醇注射似乎会显著增加急性冠状动脉综合征的风险。
