ST段抬高型心肌梗死合并肝病患者的管理与结局——来自全国再入院数据库的见解
Management and outcomes of patients with ST-elevation myocardial infarction and liver disease-Insights from the Nationwide Readmissions Database.
作者信息
Kumar Manoj, Nso Nso, Khlidj Yehya, Ali Shafaqat, Kumar Nomesh, Ponna Pramod Kumar, Attanasio Steve, Aronow Wilbert S, Butler Javed, Valencia Javier Gomez, Alaxendar Kevin M, Zelniker Thomas A, Pursnani Amit, Erwin John Preston, Ricciardi Mark J, Pareek Manan, Bangalore Sripal, Qamar Arman
机构信息
John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
Center for Cardiovascular Outcomes Research, Endeavor Health (NorthShore) Cardiovascular Institute, Glenview, IL, USA.
出版信息
Am Heart J Plus. 2025 Feb 22;52:100516. doi: 10.1016/j.ahjo.2025.100516. eCollection 2025 Apr.
BACKGROUND
The association between cardiovascular disease and advanced liver disease is incompletely understood. To explore this interaction, we compared management, clinical outcomes, readmission rates, and resource utilization in ST-elevation myocardial infarction (STEMI) patients with and without liver disease.
METHODS
The Nationwide Readmissions Database (2016-2020) was queried to identify hospitalizations for STEMI. Cohorts were stratified by presence of liver disease. Liver disease was defined as documented diagnosis of liver cirrhosis or liver failure. Multivariable regression model and propensity score matching was used to compare the risk of outcomes.
RESULTS
Among 1,029,608 hospitalizations for STEMI; 45,478 (4.4 %) patients had a history of significant liver disease. Patient with liver disease had higher baseline prevalence of diabetes, chronic kidney disease, anemia, and heart failure. After propensity matching (N = 24,067 in each group), patients with liver disease had higher in-hospital mortality (48.8 % vs 17.3 %, aOR: 6.80 [CI: 6.55-7.06], p < 0.001) and adverse events, including cerebrovascular accidents (6.8 % vs 4.4 %, aOR:1.74 [CI: 1.62-1.86], p < 0.001), cardiac arrest (24.4 % vs 10.3 %, aOR:3.34 [CI: 3.21-3.48], p < 0.001), cardiogenic shock (55.9 % vs 21.1 %, aOR: 6.4 [CI: 6.18-6.64], p < 0.001), mechanical circulatory support requirement (36.2 % vs 14.4 %, aOR: 4.2 [CI: 4.01-4.34], p < 0.001), and major adverse cardiovascular and cerebrovascular events (61.1 % vs 25.3 %, aOR:6.5 [CI: 6.28-6.75], p < 0.001). From 2016 to 2020, in-hospital mortality for STEMI did not change significantly for patients with liver disease (47.4 % to 48.6 % p-trend: 0.826), however percutaneous coronary intervention (PCI) use increased from 43.6 % to 52.2 % (p-trend <0.001).
CONCLUSION
In STEMI hospitalizations, patients with liver disease have significantly higher mortality, and adverse events as compared with those without liver disease. Despite the increasing use of primary PCI, mortality remains high in STEMI patients with liver disease.
背景
心血管疾病与晚期肝病之间的关联尚未完全明确。为探究这种相互作用，我们比较了合并和未合并肝病的ST段抬高型心肌梗死（STEMI）患者的治疗管理、临床结局、再入院率及资源利用情况。
方法
查询全国再入院数据库（2016 - 2020年）以确定STEMI住院病例。根据是否存在肝病对队列进行分层。肝病定义为有肝硬化或肝衰竭的确诊记录。采用多变量回归模型和倾向评分匹配法比较结局风险。
结果
在1,029,608例STEMI住院病例中，45,478例（4.4%）患者有严重肝病病史。肝病患者糖尿病、慢性肾病、贫血和心力衰竭的基线患病率更高。倾向评分匹配后（每组N = 24,067），肝病患者的院内死亡率更高（48.8%对17.3%，调整后比值比：6.80[置信区间：6.55 - 7.06]，p < 0.001），且不良事件发生率更高，包括脑血管意外（6.8%对4.4%，调整后比值比：1.74[置信区间：1.62 - 1.86]，p < 0.001）、心脏骤停（24.4%对10.3%，调整后比值比：3.34[置信区间：3.21 - 3.48]，p < 0.001）、心源性休克（55.9%对21.1%，调整后比值比：6.4[置信区间：6.18 - 6.64]，p < 0.001）、机械循环支持需求（36.2%对14.4%，调整后比值比：4.2[置信区间：4.01 - 4.34]，p < 0.001）以及主要不良心血管和脑血管事件（61.1%对25.3%，调整后比值比：6.5[置信区间：6.28 - 6.75]，p < 0.001）。2016年至2020年，肝病患者STEMI的院内死亡率无显著变化（47.4%至48.6%，p趋势：0.826），然而经皮冠状动脉介入治疗（PCI）的使用率从43.6%增至52.2%（p趋势<0.001）。
结论
在STEMI住院患者中，与无肝病患者相比，肝病患者的死亡率和不良事件发生率显著更高。尽管原发性PCI的使用增加，但肝病STEMI患者的死亡率仍然很高。
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