Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy With Risk of Stroke, Myocardial Infarction, and Death in Patients With Exudative Age-Related Macular Degeneration
Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy With Risk of Stroke, Myocardial Infarction, and Death in Patients With Exudative Age-Related Macular Degeneration
复制标题
DOI：
10.1001/jamaophthalmol.2018.6891
复制
发表时间：
2019-05-01
影响因子：
8.1
通讯作者：
Iezzi, Raymond
中科院分区：
文献类型：
--
作者：
Dalvin, Lauren A.;Starr, Matthew R.;Iezzi, Raymond
重要性：目前评估玻璃体内抗血管内皮生长因子（VEGF）治疗患者卒中、心肌梗死（MI）和死亡风险的研究尚无定论。据我们所知，尚未开展以人群为基础的研究来检查这些潜在风险。目的：研究接受玻璃体内抗vegf注射的渗出性年龄相关性黄斑变性（AMD）患者是否比对照组有更高的心肌梗死、卒中或死亡发生率。这项基于人群的回顾性队列研究包括来自明尼苏达州Olmsted县的504例患者，从2004年1月1日至2013年12月31日，通过罗切斯特流行病学项目（REP）数据库确定，这些患者接受了至少1次玻璃体内抗vegf注射治疗渗出性AMD。我们还研究了来自REP数据库的三个年龄和性别匹配的未接受抗vegf治疗的对照组：在抗vegf治疗之前（1990年1月1日至2003年12月31日）患有渗出性AMD的对照组，干性AMD的对照组和无AMD的对照组。数据分析时间为2016年9月1日至2017年9月1日。使用Kaplan-Meier和Cox比例风险回归模型的多变量分析，评估患者与对照组相比的5年卒中、心肌梗死和死亡风险。结果研究纳入504例患者，其中女性321例（63.7%），平均[SD]年龄76.5[10.0]岁，在研究期间接受了至少1次玻璃体内抗vegf注射治疗渗出性AMD。Kaplan-Meier分析显示5年卒中风险为7.2%，心肌梗死风险为6.1%，死亡风险为30.0%。与干性AMD患者（n = 504）、渗出性AMD患者（n = 473）或非AMD患者（n = 504）相比，接受抗vegf治疗的患者卒中或心肌梗死的风险没有增加。多因素分析显示，在抗vegf治疗前，与对照组相比，渗出性AMD的死亡率增加，但与其他对照组相比没有增加（风险比，1.63;95% CI, 1.30-2.04; P < .001）。结论和相关性：这项基于人群的研究显示，与未接受治疗的AMD患者相比，玻璃体内抗vegf治疗渗出性AMD与卒中、心肌梗死或死亡风险的持续增加无关。这些患者经历的心脏事件似乎与抗vegf治疗无关。
IMPORTANCE Current studies assessing the risk of stroke, myocardial infarction (MI), and death in patients undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy are inconclusive. To our knowledge, no population-based studies have been performed to examine these potential risks.OBJECTIVE To examine whether patients with exudative age-related macular degeneration (AMD) receiving intravitreal anti-VEGF injections have a higher incidence of MI, stroke, or death compared with control populations.DESIGN, SETTING, AND PARTICIPANTS This population-based, retrospective cohort study included 504 patients from Olmsted County, Minnesota, identified through the Rochester Epidemiology Project (REP) database as receiving at least 1 intravitreal anti-VEGF injection for exudative AMD from January 1, 2004, to December 31, 2013. Three age-and sex-matched control groups of individuals who did not receive anti-VEGF treatment and were derived from the REP database were also studied: control individuals with exudative AMD in the era before anti-VEGF (January 1, 1990, to December 31, 2003), controls with dry AMD, and controls without AMD. Data analysis was performed from September 1, 2016, to September 1, 2017.MAIN OUTCOMES AND MEASURES Five-year risk of stroke, MI, and death were assessed in patients compared with controls using Kaplan-Meier and multivariate analysis with Cox proportional hazards regression models.RESULTS The study included 504 patients (321 female [63.7%]; mean [SD] age, 76.5 [10.0] years) who received at least 1 intravitreal anti-VEGF injection for exudative AMD during the study period. Kaplan-Meier analysis revealed a 5-year risk of 7.2% for stroke, 6.1% for MI, and 30.0% for death. Patients who received anti-VEGF had no increased risk of stroke or MI compared with controls with dry AMD (n = 504), controls with exudative AMD (n = 473), or controls without AMD (n = 504). There was an increased risk of mortality compared with controls with exudative AMD in the era prior to anti-VEGF therapy but not the other control groups on multivariate analysis (hazard ratio, 1.63; 95% CI, 1.30-2.04; P < .001).CONCLUSIONS AND RELEVANCE This population-based study revealed that intravitreal anti-VEGF therapy for exudative AMD was not associated with consistent increases in the risk of stroke, MI, or death compared with no therapy in patients with or without AMD. It appears to be likely the cardiac events these patients experience are not attributable to their anti-VEGF therapy.