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肥胖症手术与心肌梗死和冠状动脉血运重建的关联:基于全国住院患者样本的倾向评分匹配分析。

The association of bariatric surgery with myocardial infarction and coronary revascularization: a propensity score match analysis of National Inpatient Sample.

机构信息

Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

出版信息

Surg Obes Relat Dis. 2024 Sep;20(9):856-863. doi: 10.1016/j.soard.2024.04.010. Epub 2024 Apr 13.

Abstract

BACKGROUND

Metabolic bariatric surgery (MBS) not only leads to a durable weight loss but also lowers mortality, and reduces cardiovascular risks.

OBJECTIVES

The current study aims to investigate the association of bariatric metabolic surgery (BMS) with admissions for acute myocardial infarction (AMI), including ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), as well as, coronary revascularization procedures, including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and thrombolysis.

SETTING

The National Inpatient Sample (NIS) database.

METHODS

The NIS data from 2016 to 2020 were analyzed. A propensity score matching in a 1:1 ratio was performed to match patients with history of MBS with non-MBS group.

RESULTS

Two hundred thirty-three thousand seven hundred twenty-nine patients from the non-MBS group were matched with 233,729 patients with history of MBS. The MBS group had about 52% reduced odds of admission for AMI compared to the non-MBS group (adjusted odd ratio: .477, 95% confidence interval: .454-.502, P value <.001). In addition, the odds of STEMI and NSEMI were significantly lower in the MBS group in comparison to the non-MBS group. Also, the MBS group had significantly lower odds of CABG, PCI, and thrombolysis compared to the non-MBS group. In addition, in patients with AMI, MBS was associated with lower in-hospital mortality (adjusted odd ratio: .627, 95% confidence interval: .469-.839, P value = .004), length of hospital stays, and total charges.

CONCLUSIONS

History of MBS is significantly associated with reduced risk of admission for AMI including STEMI and NSTEMI, as well as the, need for coronary revascularization such as PCI and CABG.

摘要

背景

代谢减重手术(MBS)不仅能持久减重,还能降低死亡率,减少心血管风险。

目的

本研究旨在调查减重代谢手术(BMS)与急性心肌梗死(AMI)入院的关系,包括 ST 段抬高型心肌梗死(STEMI)和非 ST 段抬高型心肌梗死(NSTEMI),以及经皮冠状动脉介入治疗(PCI)、冠状动脉旁路移植术(CABG)和溶栓等冠状动脉血运重建术。

设置

国家住院患者样本(NIS)数据库。

方法

分析了 2016 年至 2020 年的 NIS 数据。采用 1:1 比例的倾向评分匹配,将有 MBS 病史的患者与无 MBS 组的患者进行匹配。

结果

从无 MBS 组中匹配了 233729 例患者与有 MBS 病史的 233729 例患者。与无 MBS 组相比,MBS 组 AMI 入院的几率降低了 52%左右(调整后比值比:0.477,95%置信区间:0.454-0.502,P 值<0.001)。此外,与无 MBS 组相比,MBS 组 STEMI 和 NSTEMI 的几率显著降低。此外,与无 MBS 组相比,MBS 组 CABG、PCI 和溶栓的几率显著降低。此外,在 AMI 患者中,MBS 与较低的院内死亡率相关(调整后比值比:0.627,95%置信区间:0.469-0.839,P 值=0.004)、住院时间和总费用。

结论

MBS 病史与 AMI 入院风险降低显著相关,包括 STEMI 和 NSTEMI,以及 PCI 和 CABG 等冠状动脉血运重建术的需求。

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