慢性阻塞性肺疾病加重后心肌梗死和缺血性脑卒中。
Myocardial Infarction and Ischemic Stroke after Exacerbations of Chronic Obstructive Pulmonary Disease.
机构信息
1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
2 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
出版信息
Ann Am Thorac Soc. 2018 Aug;15(8):935-946. doi: 10.1513/AnnalsATS.201710-815OC.
RATIONALE
Previous studies have suggested that acute exacerbations of chronic obstructive pulmonary disease (COPD) may be associated with increased risk of myocardial infarction and ischemic stroke.
OBJECTIVES
We aimed to quantify the increased risks of myocardial infarction and ischemic stroke risk associated with both moderate and severe acute exacerbation, and to investigate factors that may modify these risks.
METHODS
We performed a self-controlled case series to investigate the rates of myocardial infarction and ischemic stroke after acute exacerbation compared with stable time, within individuals. The participants were 5,696 adults with COPD with a first myocardial infarction (n = 2,850) or ischemic stroke (n = 3,010) and at least one acute exacerbation from the UK Clinical Practice Research Datalink with linked Hospital Episodes Statistics data.
RESULTS
The risks of both myocardial infarction and ischemic stroke were increased in the 91 days after an acute exacerbation. The risks were greater after a severe exacerbation (incidence rate ratio [IRR], 2.58; 95% confidence interval [CI], 2.26-2.95 for myocardial infarction; and IRR, 1.97; 95% CI, 1.66-2.33 for ischemic stroke) than after a moderate exacerbation (IRR, 1.58; 95% CI, 1.46-1.71 for myocardial infarction; and IRR, 1.45; 95% CI, 1.33-1.57 for ischemic stroke). The relative risks of myocardial infarction and ischemic stroke associated with acute exacerbation were lower among those with more frequent exacerbations (IRR, 1.42; 95% CI, 1.24-1.62 vs. IRR, 1.69; 95% CI, 1.50-1.91 for myocardial infarction; and IRR, 1.30; 95% CI, 1.15-1.48 vs. IRR, 1.68; 95% CI, 1.50-1.89 for ischemic stroke). Higher GOLD stage was associated with a lower rate of myocardial infarction (IRR, 1.98; 95% CI, 1.61-2.05 vs. IRR, 1.69; 95% CI, 1.45-1.98) but not for ischemic stroke. Aspirin use at baseline was associated with a lower risk of ischemic stroke (IRR, 1.28; 95% CI, 1.10-1.50 vs. IRR, 1.63; 95% CI, 1.47-1.80) but not with myocardial infarction.
CONCLUSIONS
Acute exacerbations of COPD are associated with an increased risk of myocardial infarction and ischemic stroke within 28 days of their onset. Several patient characteristics were identified that are associated with these events.
背景
先前的研究表明，慢性阻塞性肺疾病（COPD）的急性加重可能与心肌梗死和缺血性卒中风险增加有关。
目的
我们旨在量化中度和重度急性加重与心肌梗死和缺血性卒中风险增加的关系，并研究可能改变这些风险的因素。
方法
我们进行了一项自我对照病例系列研究，以调查个体内急性加重后与稳定期相比，心肌梗死和缺血性卒中的发生率。研究对象为英国临床实践研究数据链中有首次心肌梗死（n=2850）或缺血性卒中（n=3010）的 5696 名 COPD 成人患者，以及与医院发作统计数据相关联的患者。
结果
在急性加重后 91 天内，心肌梗死和缺血性卒中的风险均增加。严重加重后的风险高于中度加重（心肌梗死的发病率比[IRR]，2.58；95%置信区间[CI]，2.26-2.95；缺血性卒中的 IRR，1.97；95%CI，1.66-2.33）。与中度加重相比（心肌梗死的 IRR，1.58；95%CI，1.46-1.71；缺血性卒中的 IRR，1.45；95%CI，1.33-1.57），急性加重与心肌梗死和缺血性卒中相关的相对风险在频繁加重的患者中较低（心肌梗死的 IRR，1.42；95%CI，1.24-1.62；缺血性卒中的 IRR，1.69；95%CI，1.50-1.91）。较高的 GOLD 分期与心肌梗死发生率较低相关（IRR，1.98；95%CI，1.61-2.05；IRR，1.69；95%CI，1.45-1.89），但与缺血性卒中无关。基线时使用阿司匹林与较低的缺血性卒中风险相关（IRR，1.28；95%CI，1.10-1.50；IRR，1.63；95%CI，1.47-1.80），但与心肌梗死无关。
结论
COPD 的急性加重与发病后 28 天内的心肌梗死和缺血性卒中风险增加有关。确定了一些与这些事件相关的患者特征。
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