Leiva Orly, Zhou Sophia, How Joan, Lee Michelle, Hobbs Gabriela
Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA; Section of Cardiology - Heart Failure, Department of Medicine, University of Chicago, Chicago, IL, USA.
Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Atherosclerosis. 2025 Feb;401:119046. doi: 10.1016/j.atherosclerosis.2024.119046. Epub 2024 Nov 1.
Myeloproliferative neoplasms (MPNs) are associated with arterial thrombosis, including acute coronary syndrome (ACS). Prior studies have suggested similar in-hospital mortality among patients with MPN compared to those without. However, post-ACS outcomes have not been thoroughly evaluated.
Patients hospitalized for ACS with and without MPN from January 2014 to December 2020 were identified using the National Readmission Database (NRD). Primary outcome was 90- and 180-day cardiovascular (CV) readmissions. Secondary outcomes were 90- and 180-day arterial thrombosis (AT), heart failure (HF), bleeding, and all-cause readmission and index hospitalization death, bleeding and arterial thrombosis (including ischemic stroke and arterial thromboembolism). Propensity score matching was used to compare outcomes between patients with and without MPN.
After PSM, 8667 patients with MPN were matched with 43,335 patients without MPN. MPN was associated with increased risk of 90- (HR 1.22, 95 % CI 1.13-1.32) and 180-day (HR 1.22, 95 % CI 1.12-1.32) readmissions. MPN was also associated with increased risk of 90- and 180-day AT, HF, bleeding, and all-cause readmissions. Among patients with MPN, MF was associated with increased risk of 90- (HR 1.36, 95 % CI 1.24-1.50) and 180- day (HR 1.34, 95 % CI 1.21-1.48) readmissions.
MPN was associated with increased risk of 90- and 180-day readmissions among patients hospitalized for ACS. Among patients with MPN, MF was associated with increased risk of 90- and 180-day CV readmissions. Further investigation is needed to improve post-ACS outcomes among patients with MPN.
骨髓增殖性肿瘤（MPN）与动脉血栓形成相关，包括急性冠状动脉综合征（ACS）。既往研究表明，MPN患者与非MPN患者的院内死亡率相似。然而，ACS后的结局尚未得到充分评估。
利用国家再入院数据库（NRD）确定2014年1月至2020年12月因ACS住院且伴有或不伴有MPN的患者。主要结局为90天和180天心血管（CV）再入院。次要结局为90天和180天动脉血栓形成（AT）、心力衰竭（HF）、出血以及全因再入院和首次住院死亡、出血和动脉血栓形成（包括缺血性卒中和动脉血栓栓塞）。采用倾向评分匹配法比较MPN患者与非MPN患者的结局。
倾向评分匹配后，8667例MPN患者与43335例非MPN患者进行了匹配。MPN与90天（风险比[HR]1.22，95%置信区间[CI]1.13 - 1.32）和180天（HR 1.22，95% CI 1.12 - 1.32）再入院风险增加相关。MPN还与90天和180天AT、HF、出血以及全因再入院风险增加相关。在MPN患者中，骨髓纤维化（MF）与90天（HR 1.36，95% CI 1.24 - 1.50）和180天（HR 1.34，95% CI 1.21 - 1.48）再入院风险增加相关。
MPN与因ACS住院患者90天和180天再入院风险增加相关。在MPN患者中，MF与90天和180天CV再入院风险增加相关。需要进一步研究以改善MPN患者的ACS后结局。
