Guo Ran, Wat Dennis, Lam Steven Ho Man, Bucci Tommaso, Tsang Christopher Tze-Wei, Cai An-Ping, Chan Yap-Hang, Ren Qing-Wen, Huang Jia-Yi, Zhang Jing-Nan, Gu Wen-Li, Zhu Ching-Yan, Hung Yik-Ming, Frost Freddy, Lip Gregory Y H, Yiu Kai-Hang
Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.
Eur Respir J. 2025 Mar 6;65(3). doi: 10.1183/13993003.01574-2024. Print 2025 Mar.
Macrolide maintenance therapy (MMT) has demonstrated notable efficacy in reducing exacerbation in patients with bronchiectasis, which is a major risk factor for cardiovascular events. However, a comprehensive assessment of the cardiovascular benefits and safety profile of MMT in this population is lacking.
This territory-wide cohort study analysed patients diagnosed with bronchiectasis in Hong Kong between 2001 and 2018. Patients were classified as MMT receivers or macrolide non-receivers based on the administration of MMT. Propensity score (PS) matching was employed for confounding factors adjustment. The primary outcome of interest was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction and stroke. The safety outcome was the occurrence of ventricular arrhythmias or sudden cardiac death. Cox proportional hazard regression analysis was utilised to compare the incidence of outcomes across the two groups.
A total of 22 895 patients with bronchiectasis were identified. Following 1:2 PS matching, the final cohort consisted of 3137 individuals, with 1123 MMT receivers and 2014 macrolide non-receivers. MMT administration was associated with a significantly reduced risk of MACE (16.38 24.11 events per 1000 person-years; hazard ratio (HR) 0.68, 95% CI 0.52-0.90). Importantly, the use of MMT was not associated with elevated risk of ventricular arrhythmias or sudden cardiac death (7.17 7.67 events per 1000 person-years; HR 0.93, 95% CI 0.60-1.44).
The administration of MMT in patients with bronchiectasis was associated with a significant reduction in the risk of MACE, without any evidence suggesting an increased risk of severe arrhythmia-related adverse events.
大环内酯维持治疗（MMT）已被证明在减少支气管扩张患者病情加重方面具有显著疗效，支气管扩张是心血管事件的主要危险因素。然而，目前缺乏对该人群中MMT的心血管益处和安全性的全面评估。
这项全地区队列研究分析了2001年至2018年期间在香港被诊断为支气管扩张的患者。根据MMT的使用情况，将患者分为MMT使用者和非大环内酯使用者。采用倾向评分（PS）匹配法对混杂因素进行调整。主要关注的结局是主要不良心血管事件（MACE），它是心血管死亡、心肌梗死和中风的综合指标。安全性结局是室性心律失常或心源性猝死的发生情况。采用Cox比例风险回归分析比较两组结局的发生率。
共识别出22895例支气管扩张患者。经过1:2的PS匹配后，最终队列由3137名个体组成，其中1123名MMT使用者和2014名非大环内酯使用者。MMT的使用与MACE风险显著降低相关（每1000人年16.38 24.11例事件；风险比（HR）0.68，95%CI 0.52 - 0.90）。重要的是，MMT的使用与室性心律失常或心源性猝死风险升高无关（每1000人年7.17 7.67例事件；HR 0.93，95%CI 0.60 - 1.44）。
支气管扩张患者使用MMT与MACE风险显著降低相关，且没有证据表明严重心律失常相关不良事件风险增加。
