Kumi Dennis D, Gajjar Rohan, Narh Joshua T, Gwira-Tamattey Edwin, Sana Muhammad, Ampaw Nana Yaa, Oduro Anna, Odoi Samuel M, Dodoo Sheriff, Fugar Setri
Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA.
Cardiology, Maimonides Medical Center, New York, USA.
Cureus. 2024 Feb 28;16(2):e55154. doi: 10.7759/cureus.55154. eCollection 2024 Feb.
Background The impact of long-term systemic steroid use on electrical and mechanical complications following ST-segment elevation myocardial infarction (STEMI) has not been extensively studied. Methods In a retrospective cohort study of the National Inpatient Sample (NIS) from 2018 to 2020, adults admitted with STEMI were dichotomized based on the presence of long-term (current) systemic steroid (LTCSS) use. The primary outcome was all-cause mortality. Secondary outcomes included a composite of mechanical complications, electrical, hemodynamic, and thrombotic complications, as well as revascularization complexity, length of stay (LOS), and total charge. Multivariate linear and logistic regressions were used to adjust for confounders. Results Out of 608,210 admissions for STEMI, 5,310 (0.9%) had LTCSS use. There was no significant difference in the odds of all-cause mortality (aOR: 0.89, 95%CI: 0.74-1.08, p-value: 0.245) and the composite of mechanical complications (aOR: 0.74, 95%CI: 0.25-2.30, p-value: 0.599). LTCSS use was associated with lower odds of ventricular tachycardia, atrioventricular blocks, new permanent-pacemaker insertion, cardiogenic shock, the need for mechanical circulatory support, mechanical ventilation, cardioversion, a reduced LOS by 1 day, and a reduced total charge by 34,512 USD (all p-values: <0.05). There were no significant differences in the revascularization strategy (coronary artery bypass graft (CABG) vs. percutaneous coronary interventions (PCI)) or in the incidence of composite thrombotic events. Conclusion LTCSS use among patients admitted with STEMI was associated with lower odds of electrical dysfunction and hemodynamic instability but no difference in the odds of mechanical complications, CABG rate, all-cause mortality, cardiac arrest, or thrombotic complications. Further prospective studies are needed to evaluate these findings further.
背景 长期全身性使用类固醇对ST段抬高型心肌梗死（STEMI）后电气和机械并发症的影响尚未得到广泛研究。方法 在一项对2018年至2020年全国住院患者样本（NIS）的回顾性队列研究中，因STEMI入院的成年人根据是否长期（当前）全身性使用类固醇（LTCSS）进行二分法分类。主要结局是全因死亡率。次要结局包括机械并发症、电气、血流动力学和血栓形成并发症的综合情况，以及血运重建复杂性、住院时间（LOS）和总费用。使用多变量线性和逻辑回归来调整混杂因素。结果 在608,210例STEMI入院病例中，5310例（0.9%）使用了LTCSS。全因死亡率的比值比（aOR：0.89，95%置信区间：0.74 - 1.08，p值：0.245）和机械并发症综合情况的比值比（aOR：0.74，95%置信区间：0.25 - 2.30，p值：0.599）无显著差异。使用LTCSS与室性心动过速、房室传导阻滞、新的永久性起搏器植入、心源性休克、机械循环支持需求、机械通气、心脏复律的较低比值比相关，住院时间减少1天，总费用减少34,512美元（所有p值：<0.05）。血运重建策略（冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI））或复合血栓形成事件的发生率无显著差异。结论 STEMI入院患者中使用LTCSS与较低的电气功能障碍和血流动力学不稳定比值比相关，但在机械并发症比值比、CABG率、全因死亡率、心脏骤停或血栓形成并发症方面无差异。需要进一步的前瞻性研究来进一步评估这些发现。
