Impact of Psoriasis on Mortality Rate and Outcome in Myocardial Infarction.
Impact of Psoriasis on Mortality Rate and Outcome in Myocardial Infarction.
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DOI：
10.1161/jaha.120.016956
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发表时间：
2020-09-15
影响因子：
5.4
通讯作者：
Keller K
中科院分区：
文献类型：
--
作者：
Karbach S;Hobohm L;Wild J;Münzel T;Gori T;Wegner J;Steinbrink K;Wenzel P;Keller K
银屑病是一种常见的慢性炎症性细胞因子介导的皮肤病，是心肌梗死(MI)发生的独立危险因素。然而，在MI的背景下，关于牛皮癣对死亡率和其他院内不良事件的影响的数据是稀少的和不一致的。采用2005年至2016年德国全国住院患者样本进行统计分析。对心肌梗塞住院患者进行银屑病的分层，并调查银屑病对住院事件的影响。总体而言，在德国(2005年至2016年)，有3/307-703名MI患者(37.6%的女性，56.8%的年龄为70岁的≥)接受治疗；其中9,028人(0.3%)被诊断为牛皮癣。患有银屑病的心肌梗塞患者明显年轻(68.0vs73.0vs73.0vs62.0vs81.0a；P<；0.001)，并且显示出显著较低的住院病死率(7.1%vs12.4%；p<；0.001)，经年龄、性别和合并症调整后的回归分析证实(优势比0.68%；95%CI0.63-0.74p<；0.001)。他们更常发现心血管危险因素，如动脉高血压(58.9%比55.0%；P<；0.001)、高脂血症(44.4%比38.6%；P<；0.001)、吸烟(14.3%比7.4%；P<；0.001)、糖尿病(34.8%比30.4%；P<；0.001)或肥胖(17.9%比9.3%；P<；0.001)。虽然两组患者经皮冠状动脉介入治疗的比率(41.4%比42.0%；P=0.223)相似，但心肌梗死合并银屑病的患者更常接受冠状动脉旁路手术(7.7%比4.7%；P<；0.001)。总体而言，只有0.3%的心肌梗死患者被诊断为牛皮癣，患有牛皮癣的心肌梗死患者比没有牛皮癣的心肌梗死患者年轻5岁。银屑病似乎增加了经典的心血管危险因素的患病率，因此可能解释了MI的早期时间点。我们的数据还显示，患有银屑病的心肌梗塞患者的住院死亡率较低，这可能是由于年龄较小所致。
Psoriasis is a frequent chronic inflammatory cytokine‐mediated skin disease and was identified to be an independent risk factor for the occurrence of myocardial infarction (MI). However, data about the impact of psoriasis on mortality and other in‐hospital adverse events in the setting of MI are sparse and inconsistent. The nationwide German inpatient sample of the years 2005 to 2016 was used for statistical analysis. Hospitalized patients with MI were stratified for the presence of psoriasis and the impact of psoriasis on in‐hospital events was investigated. Overall, 3 307 703 patients with MI (37.6% females, 56.8% aged ≥70 years) were treated in Germany (2005–2016); among them 9028 (0.3%) were diagnosed with psoriasis. Patients with MI with psoriasis were significantly younger (68.0 [58.0–76.0] versus 73.0 [62.0–81.0] years; P<0.001) and showed significant lower in‐hospital case‐fatality rate (7.1% versus 12.4%; P<0.001), confirmed in the regression (odds ratio, 0.68; 95% CI, 0.63–0.74; P<0.001) adjusted for age, sex, and comorbidities. They more frequently revealed cardiovascular risk factors such as arterial hypertension (58.9% versus 55.0%; P<0.001), hyperlipidemia (44.4% versus 38.6%; P<0.001), smoking (14.3% versus 7.4%; P<0.001), diabetes mellitus (34.8% versus 30.4%; P<0.001) or obesity (17.9% versus 9.3%; P<0.001). While the rate of percutaneous coronary intervention (41.4 versus 42.0%; P=0.223) was comparable between both groups, coronary bypass surgery was more often performed in patients with MI with psoriasis (7.7% versus 4.7%; P<0.001). Overall, only 0.3% of all MI cases were diagnosed with psoriasis, and patients with MI with psoriasis were in median 5 years younger than patients with MI without psoriasis. Psoriasis seems to enhance the prevalence of classical cardiovascular risk factors and might therefore explain the earlier time point for MI. Our data also showed in turn a lower in‐hospital mortality rate in patients with MI with psoriasis, presumably driven by younger age.