Acute respiratory-tract infections and risk of first-time acute myocardial infarction
Acute respiratory-tract infections and risk of first-time acute myocardial infarction
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DOI：
10.1016/s0140-6736(97)11084-4
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发表时间：
1998-05-16
期刊：
影响因子：
168.9
通讯作者：
Jick, H
中科院分区：
文献类型：
--
作者：
Meier, CR;Jick, SS;Jick, H
背景感染在急性心肌梗死（AMI）病因学中的作用越来越受到关注。我们进行了一项大型的、以人群为基础的研究，以探讨AMI风险与近期急性呼吸道感染之间的关系。潜在的病例是年龄在75岁或以下的人，没有临床危险因素的历史，在1994年1月1日至1996年10月31日之间首次诊断为AMI。四个对照组与每个病例的年龄、性别和参加的实践相匹配。将病例中的AMI日期定义为索引日期。对于病例组和对照组，确定索引日期之前的最后一次泌尿道感染日期。我们还对索引日期前或任意选择日期前（AMI前1年）发生急性呼吸道感染的病例进行了病例交叉分析。在对1922例病例和7649例匹配对照的病例对照分析中，在索引日期前10天内发生急性泌尿道感染的病例显著多于对照（54例[2.8%] vs 72例[0.9%]）。首次AMI与索引日期前1-5、6-10、11- 1 - 5或16-30天的急性呼吸道感染相关的比值比，经吸烟和体重指数校正（与前一年没有感染的参与者相比）为3.6（95% CI 2.2-5.7）、2.3（1.3-4.2）、1.8（1.0-3.3）和1.0（0.7-1.6）;（趋势检验p < 0.01）。病例交叉分析显示，与指标日期前10天内的急性呼吸道感染相关的AMI相对风险为2.7（1.6-4.7）。解释。我们的研究结果表明，在没有AMI临床危险因素病史的人群中，急性呼吸道感染与AMI风险增加相关，持续约2周。然而，如果AMI的前驱症状被误认为是呼吸道感染，我们不能完全排除误诊偏见的可能性。
Background. There is growing interest in the role of infections in the aetiology of acute myocardial infarction (AMI). We undertook a large, population-based study to explore the association between risk of AMI and recent acute respiratory-tract infectionMethods We used data from general practices in the UK (General Practice Research Database). Potential cases were people aged 75 years or younger, with no history of clinical risk factors, who had a first-time diagnosis of AMI between Jan 1, 1994, and Oct 31, 1996. Four controls were matched to each case on age, sex, and the practice attended. The date of the AMI in the case was defined as the index date. For both cases and controls the date of the last respiratory-tract infection before the index date was identified. We also did a case-crossover analysis of cases who had an acute respiratory-tract infection either before the index date or before an arbitrarily chosen date (1 year before AMI).Findings. In the case-control analysis of 1922 cases and 7649 matched controls, significantly more cases than controls had an acute respiratory-tract infection in the 10 days before the index date (54 [2.8%] vs 72 [0.9%]). The odds ratios, adjusted for smoking and body-mass index, for first-time AMI in association with an acute respiratory-tract infection 1-5, 6-10, 11-15, or 16-30 days before the index date (compared with participants who had no such infection during the preceding year) were 3.6 (95% CI 2.2-5.7), 2.3 (1.3-4.2), 1.8 (1.0-3.3), and 1.0 (0.7-1.6); (test for trend p < 0.01). The case-crossover analysis showed a relative risk of 2.7 (1.6-4.7) for AMI in relation to an acute respiratory-tract infection in the 10 days before the index date.Interpretation. Our findings suggest that in people without a history of clinical risk factors for AMI, acute respiratory-tract infections are associated with an increased risk of AMI for a period of about 2 weeks. We cannot, however, completely exclude the possibility of misdiagnosis bias, if prodromal symptoms of AMI were mistaken for respiratory-tract infection.