Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Scand J Gastroenterol. 2024 Sep;59(9):1069-1074. doi: 10.1080/00365521.2024.2375772. Epub 2024 Aug 1.
BACKGROUND & AIMS: Alcohol-related cirrhosis (ALD cirrhosis) has a weaker effect on acute myocardial infarction (MI) than on other arterial or venous thromboses, and the reasons for this pattern are unclear. This study aimed to identify risk factors of MI amongst patients with ALD cirrhosis.
This nationwide register-based nested case-control study was conducted within a cohort of all Danish patients diagnosed with ALD cirrhosis from 2000-2019. Patients with first-time MI after diagnosis of ALD cirrhosis were identified as cases, and matching cohort members (10:1) with no history of MI, using risk-set sampling. We selected candidate risk factors and used conditional logistic regression to study the association between them and the adjusted odds ratio of MI.
We included 373 cases and 3,730 controls. We identified the following risk factors for MI: hospitalization for infection (adjusted odds ratio 2.26 [95% CI 1.38-3.71]), recent surgery (adjusted odds ratio 1.82 [95% CI 1.18-2.81]), history of atherosclerosis (adjusted odds ratio 1.89 [95% CI 1.39-2.57]), cardiac ischemia (adjusted odds ratio 6.23 [95% CI 4.30-9.04]), heart failure (adjusted odds ratio 2.83 [95% CI 1.90-4.22]) or chronic obstructive pulmonary disease (COPD) (adjusted odds ratio 2.26 [95% CI 1.62-3.17]). Use of anticoagulants had a protective effect (adjusted odds ratio 0.47 [95% CI 0.25-0.91]). Our findings contribute to the understanding of risk factors for MI in patients with ALD cirrhosis. They may have clinical implications e.g. for the decision to offer thromboprophylaxis.
酒精性肝硬化（ALD 肝硬化）对急性心肌梗死（MI）的影响弱于其他动脉或静脉血栓形成，其原因尚不清楚。本研究旨在确定 ALD 肝硬化患者发生 MI 的危险因素。
本研究是一项基于人群的全国性嵌套病例对照研究，在 2000 年至 2019 年间丹麦所有被诊断为 ALD 肝硬化的患者队列中进行。在确诊 ALD 肝硬化后首次发生 MI 的患者被确定为病例，采用风险集抽样法匹配无 MI 病史的队列成员（10:1）。我们选择了候选危险因素，并使用条件逻辑回归研究它们与 MI 调整后比值比之间的关系。
我们纳入了 373 例病例和 3730 例对照。我们确定了 MI 的以下危险因素：感染住院（调整后的比值比 2.26 [95%可信区间 1.38-3.71]）、近期手术（调整后的比值比 1.82 [95%可信区间 1.18-2.81]）、动脉粥样硬化史（调整后的比值比 1.89 [95%可信区间 1.39-2.57]）、心肌缺血（调整后的比值比 6.23 [95%可信区间 4.30-9.04]）、心力衰竭（调整后的比值比 2.83 [95%可信区间 1.90-4.22]）或慢性阻塞性肺疾病（COPD）（调整后的比值比 2.26 [95%可信区间 1.62-3.17]）。使用抗凝剂具有保护作用（调整后的比值比 0.47 [95%可信区间 0.25-0.91]）。我们的研究结果有助于了解 ALD 肝硬化患者发生 MI 的危险因素。这些结果可能具有临床意义，例如在决定是否进行血栓预防方面。
