Pellegrini James R, Munshi Rezwan F, Farraj Kristen, Russe-Russe Jose R, Abdou Amr, Shah Kashyap, Lannom Madison, Rizvon Kaleem, Mustacchia Paul
Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York.
Department of Internal Medicine, St. Lukes University Health Network, Bethlehem, Pennsylvania.
Gastro Hep Adv. 2022 May 16;1(5):770-774. doi: 10.1016/j.gastha.2022.04.018. eCollection 2022.
We aimed to study the impact of acute myocardial infarction (AMI) in patients with celiac disease (CD).
We used the National Inpatient Sample 2011-2018 to identify patients aged 18 years and older with a history of CD who presented with AMI using International Classification of Disease Nineth and Tenth Revision codes. Primary outcome of interest was mortality differences in AMI patients with and without CD. Secondary outcomes were in-hospital length of stay, hospital costs, and coronary revascularization.
A total of 2,287,840 weighted patients were included in this study with a principal diagnosis of AMI. Among this population, 183,027 weighted patients had a history of CD (0.08%), and 2,286,010 weighted patients had AMI without a history of CD (99.92%). Most AMI patients with and without CD were older (69.57 ± 13.21 vs 67.08 ± 13.87 years, respectively) and white (92.55% vs 75.39%, respectively). Patients with AMI and CD were more likely to be female than patients without CD (53.76% vs 38.47%; < .05). In our study, we found that the difference in hospital charges (adjusted mean difference $2644.7) was lower among AMI and CD; however, length of stay was higher among patients with CD (adjusted mean difference 0.36 day) although they were not statistically significant ( > .05). Both cohorts had higher number of Medicare recipients and lower number of patients who self-pay. Our study also found that smoking was more prevalent among patients with CD, 12.14%, vs patients without CD, 2.51%. Moreover, patients with CD who developed AMI had a lower adjusted odds of mortality than those without CD (adjusted odds ratio [aOR] 0.41; < .05). Patients with CD and AMI also had lower odds of coronary revascularization (aOR 0.80; < .05). In addition, we found that adults with CD had a lower odds of developing AMI (aOR 0.78; < .05).
CD is a chronic disease leading to chronic inflammation and various nutrition-related problems which can lead to increased morbid conditions. However, we found lower odds of AMI among patients with CD, as well as lower mortality and comorbidities related to AMI, thus contradicting previous assumptions.
我们旨在研究急性心肌梗死（AMI）对乳糜泻（CD）患者的影响。
我们使用2011 - 2018年全国住院患者样本，通过国际疾病分类第九版和第十版编码来识别18岁及以上有CD病史且出现AMI的患者。感兴趣的主要结局是有和没有CD的AMI患者的死亡率差异。次要结局包括住院时间、住院费用和冠状动脉血运重建。
本研究共纳入2287840例加权患者，主要诊断为AMI。在这一人群中，183027例加权患者有CD病史（0.08%），2286010例加权患者有AMI但无CD病史（99.92%）。大多数有和没有CD的AMI患者年龄较大（分别为69.57±13.21岁和67.08±13.87岁）且为白人（分别为92.55%和75.39%）。有AMI且有CD的患者比没有CD的患者更可能为女性（53.76%对38.47%；P<0.05）。在我们的研究中，我们发现有AMI且有CD的患者住院费用差异（调整后平均差异2644.7美元）较小；然而，有CD的患者住院时间较长（调整后平均差异0.36天），尽管差异无统计学意义（P>0.05）。两个队列中医疗保险受益人数较多，自费患者人数较少。我们的研究还发现，CD患者中吸烟更为普遍，为12.14%，而无CD患者中为2.51%。此外，发生AMI的CD患者调整后的死亡几率低于无CD的患者（调整后优势比[aOR]0.41；P<0.05）。有CD且有AMI的患者冠状动脉血运重建几率也较低（aOR 0.80；P<0.05）。此外，我们发现患有CD的成年人发生AMI的几率较低（aOR 0.78；P<0.05）。
CD是一种导致慢性炎症和各种营养相关问题的慢性疾病，这些问题可导致病情加重。然而，我们发现CD患者发生AMI的几率较低，以及与AMI相关的死亡率和合并症较低，这与先前的假设相矛盾。
