Berglund Lars, Rönnegård Ann-Sofie, Lindahl Bertil, Äng Björn, Gordh Torsten, Hambraeus Kristina, Ärnlöv Johan
School of Health and Welfare, Dalarna University, Falun, Sweden.
Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden.
Int J Cardiol Heart Vasc. 2025 Jun 18;59:101719. doi: 10.1016/j.ijcha.2025.101719. eCollection 2025 Aug.
Pain is associated with cardiovascular risk, but its prognosis after myocardial infarction (MI) is less studied. We evaluated general pain post-MI as a marker for MACE (all-cause mortality, recurrent MI, or stroke) and all-cause mortality.
We collected data from 98,441 MI patients (22-79 years) from the Swedish quality register SWEDEHEART. Pain, measured by EuroQol-5, was recorded one-year post-MI. Moderate pain was reported by 38.0 % of the patients and extreme pain by 5.0 %. During follow-up (up to 16.0 years (median 5.5 years)) there were 14,944 deaths and 24,910 MACEs.In adjusted Cox regression models, moderate and extreme pain were associated with all-cause mortality in men (hazard ratio (HR) 1.24, 95 % confidence interval (CI) 1.19-1.29 and HR 1.70, 95 % CI 1.54-1.86, respectively,) and in women (HR 1.15, 95 % CI 1.08-1.23 and HR 1.31, 95 % CI 1.16-1.48, respectively,). The population attributable fraction (PAF) for moderate and extreme pain combined, with outcome all-cause mortality, was 8.3% for men and 6.3 % for women, similar to PAF for smoking, diabetes, and hypertension. Compared to all-cause mortality, HRs for MACE were somewhat lower in men and similar in women. For patients with lower cardiovascular risk defined, among other factors, by absence of chest pain, HRs were comparable to those in the main sample.
Self-reported pain after MI was common and linked to increased cardiovascular risk, similar to that of smoking, diabetes, and hypertension. Clinicians may consider general pain in prognosis and treatment, even for patients without chest pain.
疼痛与心血管风险相关，但心肌梗死（MI）后疼痛的预后研究较少。我们评估了心肌梗死后的一般疼痛作为主要不良心血管事件（MACE，包括全因死亡率、复发性心肌梗死或中风）和全因死亡率的标志物。
我们从瑞典质量登记处SWEDEHEART收集了98441例心肌梗死患者（年龄22 - 79岁）的数据。采用欧洲五维健康量表（EuroQol-5）测量疼痛，在心肌梗死后1年记录。38.0%的患者报告有中度疼痛，5.0%的患者报告有极度疼痛。在随访期间（长达16.0年（中位时间5.5年）），有14944例死亡和24910例发生主要不良心血管事件。在调整后的Cox回归模型中，中度和极度疼痛与男性全因死亡率相关（风险比（HR）分别为1.24，95%置信区间（CI）为1.19 - 1.29和HR 1.70，95% CI为1.54 - 1.86），与女性全因死亡率相关（HR分别为1.15，95% CI为1.08 - 1.23和HR 1.31，95% CI为1.16 - 1.48）。中度和极度疼痛合并导致全因死亡的人群归因分数（PAF），男性为8.3%，女性为6.3%，与吸烟、糖尿病和高血压的PAF相似。与全因死亡率相比，男性发生主要不良心血管事件的HR略低，女性相似。对于由无胸痛等因素定义的心血管风险较低的患者，HR与主要样本中的患者相当。
心肌梗死后自我报告的疼痛很常见，且与心血管风险增加有关，类似于吸烟、糖尿病和高血压。临床医生在预后和治疗中可能需要考虑一般疼痛情况，即使对于无胸痛的患者也是如此。
