一项全国性研究：II 型肺动脉高压对因 ST 段抬高型心肌梗死入院的充血性心力衰竭患者的影响
The impact of group II pulmonary hypertension on congestive heart failure patients admitted with ST elevation myocardial infarction, a nationwide study.
作者信息
El Labban Mohamad, Mir Mikael R, Abruzzo Alexandra, Boike Sydney, Niaz Fayreal A, Vo Natasha T, Rauf Ibtisam, Khan Syed A
机构信息
Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA.
School of Medicine, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Thorac Dis. 2024 Jul 30;16(7):4120-4127. doi: 10.21037/jtd-24-221. Epub 2024 Jul 5.
BACKGROUND
Pulmonary hypertension (PH) is a condition where the blood pressure increases in the pulmonary arteries, leading to reduced oxygen delivery to the body's tissues due to increased blood flow resistance. This condition can result in right ventricular hypertrophy, low cardiac output, and ischemia. In this study, the authors aim to investigate the impact of group II PH (GIIPH) on patients with congestive heart failure who were admitted with ST elevation myocardial infarction (STEMI) through a retrospective cohort study.
METHODS
Using the National Inpatient Sample (NIS) database from 2017 to 2020, a retrospective cross-sectional study of adult patients with a principal diagnosis of STEMI with a secondary diagnosis with or without GIIPH according to ICD-10 (International Classification of Disease, 10th edition) codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included cardiogenic shock, mechanical intubation, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a P value less than 0.05 considered statistically significant.
RESULTS
The study included 26,925 patients admitted with a STEMI, 95 of whom had GIIPH. The mean age for patients with and without PH was 66.6 and 67.5 years, respectively. In the PH group, 37% were females compared to 34% in the non-PH group. The in-hospital mortality rate was higher in the PH group (31.6% 9.6%, P<0.001, adjusted odds ratio (aOR) =3.33, P=0.02). The rates and adjusted odds of cardiogenic shock and mechanical ventilation were higher in the PH groups (aOR =1.15 and 2.14, respectively) but not statistically significant. Patients with PH had a longer length of stay and a higher total charge.
CONCLUSIONS
GIIPH was associated with worse clinical and economic outcomes in heart failure patients admitted with STEMI.
背景
肺动脉高压（PH）是一种肺动脉血压升高的病症，由于血流阻力增加，导致身体组织的氧气输送减少。这种病症可导致右心室肥大、心输出量降低和局部缺血。在本研究中，作者旨在通过一项回顾性队列研究，调查II型肺动脉高压（GIIPH）对因ST段抬高型心肌梗死（STEMI）入院的充血性心力衰竭患者的影响。
方法
利用2017年至2020年的全国住院患者样本（NIS）数据库，对主要诊断为STEMI且根据ICD-10（国际疾病分类第10版）编码有或无GIIPH二级诊断的成年患者进行回顾性横断面研究。分析了包括年龄、种族和性别在内的几个人口统计学特征。主要终点是死亡率，次要终点包括心源性休克、机械通气、住院天数和患者费用（以美元计）。采用多变量逻辑回归模型分析来调整混杂因素，P值小于0.05被认为具有统计学意义。
结果
该研究纳入了26925例因STEMI入院的患者，其中95例患有GIIPH。有和没有PH的患者的平均年龄分别为66.6岁和67.5岁。在PH组中，37%为女性，非PH组为34%。PH组的院内死亡率更高（31.6%对9.6%，P<0.001，调整后的优势比（aOR）=3.33，P=0.02）。PH组的心源性休克和机械通气的发生率及调整后的优势比更高（分别为aOR =1.15和2.14），但无统计学意义。患有PH的患者住院时间更长，总费用更高。
结论
GIIPH与因STEMI入院的心力衰竭患者更差的临床和经济结局相关。
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