冠状动脉疾病患者肺炎后不良心脏事件的风险

Benjamin Bartlett, Frank M Sanfilippo, Silvia Lee, Herbert Ludewick, Grant Waterer, Adil Rajwani, Chrianna Bharat, Abdul Rahman Ihdayhid, Vicente Corrales-Medina, Girish Dwivedi
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引用次数: 0

摘要

理由:肺炎引发炎症反应,可持续到感染消退后。这可能会增加已知冠状动脉疾病(CAD)患者发生主要不良心脏事件(MACE)的风险。目的:评估肺炎对已存在CAD患者MACE的影响。方法:我们确定了2000-2005年间在西澳大利亚7家主要医院接受冠状动脉重建术的患者。多变量Cox回归模型分别评估了时间依赖性肺炎与MACE[全因死亡+心肌梗死(MI) +不稳定心绞痛+缺血性卒中+心力衰竭(HF)的组合]和各组成结果之间的关系,随访时间为30天,随访时间为1年,随访时间为1年。测量:研究队列中有14425例患者(平均年龄64.4岁,女性23.6%)。在长达13年的随访中,988例患者经历了≥1次肺炎住院治疗。主要结果:MACE的风险随着时间的推移而增加,30天和1年的调整风险比(aHR)分别为4.91 (95% CI 1.21-20.00)和4.91 (CI 2.62-9.19),整个随访期间的aHR为11.41 (CI 9.22-14.11)。心肌梗死风险在前30天最高(aHR 11.34),在1年的随访间隔和剩余随访时间内降低(aHR分别为2.27和2.63)。在整个随访期间,HF和心血管死亡的风险也很高(aHR分别为10.39和12.25)。结论:肺炎住院显著增加冠心病患者发生MACE的短期和长期风险。应该更好地了解潜在的机制,以制定有针对性的干预措施,以减少这一高危人群的MACE。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Risk of Adverse Cardiac Events after Pneumonia in Patients with Coronary Artery Disease.

Rationale: Pneumonia triggers an inflammatory response that can persist even after the infection is resolved. This may further increase the risk of major adverse cardiac events (MACE) in individuals with known coronary artery disease (CAD), though this remains unclear. Objectives: We aimed to assess the impact of pneumonia on MACE in individuals with existing CAD. Methods: We identified patients who had coronary artery revascularization procedures in seven major hospitals in Western Australia between 2000 and 2005. Multivariable Cox regression models assessed the association between time-dependent pneumonia and MACE (composite of all-cause death + myocardial infarction + unstable angina + ischemic stroke + heart failure) and component outcomes separately, over 30 days, 1 year, and full follow-up. Results: There were 14,425 patients in the study cohort (mean age, 64.4 yr; 23.6% female). Over a maximum of 13 years of follow-up, 988 patients experienced one or more pneumonia hospitalization. The risk of MACE increased over time, with adjusted hazard ratios (aHRs) of 4.91 (95% confidence interval [CI], 1.21-20.00) and 4.91 (95% CI, 2.62-9.19) over 30-day and 1-year intervals, respectively, and an aHR of 11.41 (95% CI, 9.22-14.11) over the entire follow-up. Myocardial infarction risk was highest during the first 30 days (aHR, 11.34) and reduced over the 1-year interval and the remainder of follow-up (aHR, 2.27 and 2.63, respectively). Risk of heart failure and cardiovascular death were also high over the entire follow-up period (aHR, 10.39 and 12.25, respectively). Conclusions: Pneumonia hospitalization is associated with a significantly increased risk of MACE in patients with CAD. Underlying mechanisms should be better understood to develop targeted interventions to reduce MACE in this already high-risk population.

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