Meier C R, Jick S S, Derby L E, Vasilakis C, Jick H
Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Lexington, MA 02173, USA.
Lancet. 1998 May 16;351(9114):1467-71. doi: 10.1016/s0140-6736(97)11084-4.
There is growing interest in the role of infections in the aetiology of acute myocardial infarction (AMI). We undertook a large, population-based study to explore the association between risk of AMI and recent acute respiratory-tract infection.
We used data from general practices in the UK (General Practice Research Database). Potential cases were people aged 75 years or younger, with no history of clinical risk factors, who had a first-time diagnosis of AMI between Jan 1, 1994, and Oct 31, 1996. Four controls were matched to each case on age, sex, and the practice attended. The date of the AMI in the case was defined as the index date. For both cases and controls the date of the last respiratory-tract infection before the index date was identified. We also did a case-crossover analysis of cases who had an acute respiratory-tract infection either before the index date or before an arbitrarily chosen date (1 year before AMI).
In the case-control analysis of 1922 cases and 7649 matched controls, significantly more cases than controls had an acute respiratory-tract infection in the 10 days before the index date (54 [2.8%] vs 72 [0.9%]). The odds ratios, adjusted for smoking and body-mass index, for first-time AMI in association with an acute respiratory-tract infection 1-5, 6-10, 11-15, or 16-30 days before the index date (compared with participants who had no such infection during the preceding year) were 3.6 (95% CI 2.2-5.7), 2.3 (1.3-4.2), 1.8 (1.0-3.3), and 1.0 (0.7-1.6); (test for trend p<0.01). The case-crossover analysis showed a relative risk of 2.7 (1.6-4.7) for AMI in relation to an acute respiratory-tract infection in the 10 days before the index date.
Our findings suggest that in people without a history of clinical risk factors for AMI, acute respiratory-tract infections are associated with an increased risk of AMI for a period of about 2 weeks. We cannot, however, completely exclude the possibility of misdiagnosis bias, if prodromal symptoms of AMI were mistaken for respiratory-tract infection.
感染在急性心肌梗死（AMI）病因学中的作用日益受到关注。我们开展了一项基于人群的大型研究，以探讨AMI风险与近期急性呼吸道感染之间的关联。
我们使用了英国全科医疗的数据（全科医疗研究数据库）。潜在病例为年龄在75岁及以下、无临床危险因素病史且在1994年1月1日至1996年10月31日期间首次诊断为AMI的患者。按照年龄、性别和就诊诊所为每个病例匹配4名对照。将病例中AMI的日期定义为索引日期。对于病例和对照，均确定索引日期前最后一次呼吸道感染的日期。我们还对在索引日期前或在任意选定日期（AMI前1年）前发生急性呼吸道感染的病例进行了病例交叉分析。
在对1922例病例和7649例匹配对照的病例对照分析中，在索引日期前10天内发生急性呼吸道感染的病例显著多于对照（54例[2.8%]对72例[0.9%]）。在调整吸烟和体重指数后，与索引日期前1 - 5天、6 - 10天、11 - 15天或16 - 30天发生急性呼吸道感染相关的首次AMI的比值比（与前一年无此类感染的参与者相比）分别为3.6（95%CI 2.2 - 5.7）、2.3（1.3 - 4.2）、1.8（1.0 - 3.3）和1.0（0.7 - 1.6）；（趋势检验p<0.01）。病例交叉分析显示，与索引日期前10天内发生急性呼吸道感染相关的AMI相对风险为2.7（1.6 - 4.7）。
我们的研究结果表明，在无AMI临床危险因素病史的人群中，急性呼吸道感染在约2周的时间内与AMI风险增加相关。然而，如果将AMI的前驱症状误诊为呼吸道感染，我们不能完全排除误诊偏倚的可能性。
