Increased Risk of Myocardial Infarction and Stroke Following Exacerbation of COPD
Increased Risk of Myocardial Infarction and Stroke Following Exacerbation of COPD
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DOI：
10.1378/chest.09-2029
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发表时间：
2010-05-01
期刊：
影响因子：
9.6
通讯作者：
Wedzicha, Jadwiga A.
中科院分区：
文献类型：
--
作者：
Donaldson, Gavin C.;Hurst, John R.;Wedzicha, Jadwiga A.
目的：COPD患者有发生心血管事件的危险。这是由于全身炎症增加。慢性阻塞性肺疾病的过程是由急性加重，这进一步增加全身炎症，但血管事件的风险在postexacerbation期间从来没有defined.Methods：我们分析了数据从25,857名COPD患者进入健康改善网络数据库超过2年的时间。急性加重使用口服皮质类固醇>20 mg/d和/或选定的口服抗生素处方的卫生保健使用定义来定义。心肌梗死（MI）和中风的风险在postexacerbation期间计算相对于患者的基线风险使用的自我对照病例系列approach.Results：我们确定了524 MI在426例患者和633缺血性中风在482例患者。MI和卒中的发生率分别为1.1和1.4/100患者-年。急性发作后1 - 5天MI风险增加2.27倍（95%CI，1.1-4.7; P = 0.03）（定义为类固醇和抗生素处方）。该相对风险随时间逐渐降低，与基线MI风险在任何其他加重后时间间隔无显著差异。1/2，513的急性加重与1至5天内的MI相关。急性加重后1 ~ 49天中风风险增加1.26倍（95%CI，1.0-1.6; P = 0.05）。结论：结果表明，COPD急性加重增加MI和中风的风险。这可能对稳定期和恶化期COPD的治疗产生影响。胸部2010; 137（5）：1091-1097
Objective: Patients with COPD are at risk for cardiovascular events. This is attributed to increased systemic inflammation. The course of COPD is punctuated by exacerbations, which further increase systemic inflammation, but the risk of vascular events in the postexacerbation period has never been defined.Methods: We analyzed data from 25,857 patients with COPD entered in The Health Improvement Network database over a 2-year period. Exacerbations were defined using a health-care use definition of prescription of oral corticosteroids >20 mg/d and/or selected oral antibiotics. The risk of myocardial infarction (MI) and stroke in the postexacerbation period was calculated relative to the patient's baseline risk using the self-controlled case series approach.Results: We identified 524 MIs in 426 patients and 633 ischemic strokes in 482 patients. The incidence rates of MI and stroke were 1.1 and 1.4 per 100 patient-years, respectively. There was a 2.27-fold (95% CI, 1.1-4.7; P = .03) increased risk of MI 1 to 5 days after exacerbation (defined by prescription of both steroids and antibiotics). This relative risk diminished progressively with time and was not significantly different from the baseline MI risk at any other postexacerbation time interval. One in 2,513 exacerbations was associated with MI within 1 to 5 days. There was a 1.26-fold (95% CI, 1.0-1.6; P = .05) increased risk of stroke 1 to 49 days after exacerbation.Conclusion: The results suggest that exacerbations of COPD increase the risk of MI and stroke. This may have implications for therapy in both stable and exacerbated COPD. CHEST 2010; 137(5):1091-1097