Mortality after coronary artery revascularization of patients with rheumatoid arthritis
Mortality after coronary artery revascularization of patients with rheumatoid arthritis
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DOI：
10.1016/j.jtcvs.2009.09.036
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发表时间：
2010-07-01
影响因子：
6
通讯作者：
Francis, Mark L.
中科院分区：
文献类型：
--
作者：
Varghese, Joji J.;Koneru, Sushma;Francis, Mark L.
目的：类风湿性关节炎患者发生加速性关节硬化的风险增加。然而，目前尚不清楚这种疾病是否与冠状动脉血运重建术后并发症的高风险有关。方法：我们对2003-2005年全国住院患者样本中的患者进行了横断面研究。为了确定类风湿性关节炎患者在冠状动脉血运重建术后是否有更高的住院死亡率，我们使用logistic回归来调整年龄、性别、种族/民族、收入、城乡居住、糖尿病、高血压、高脂血症、Charlson合并症（包括心肌梗死、充血性心力衰竭和糖尿病）、择期入院、周末入院和主要支付者。在接受冠状动脉血运重建的患者中，调整上述混杂因素后，类风湿性关节炎患者住院期间死亡的可能性比非类风湿性关节炎患者低49%（比值比，0.51; 95%置信区间，0.40-0.65）。在调整相同混杂因素的亚组分析中，类风湿性关节炎患者接受经皮冠状动脉介入治疗后，住院死亡率也改善了61%（比值比，0.39; 95%置信区间，0.29-0.54），沿着减少了中位住院天数0.32（95%置信区间，0.28-0.34天）。同样，类风湿性关节炎患者接受冠状动脉旁路移植术后，住院死亡率降低了31（比值比，0.69; 95%置信区间，0.48-0.99），平均住院天数减少1.36天（95%置信区间，0.72-1.12天）。在接受冠状动脉血运重建的患者中，风湿性关节炎的治疗方法有哪些？与非类风湿性关节炎患者相比，住院生存率沿着降低，住院天数减少。（《胸血管外科杂志》2010;140：91-6）
Objective: Patients with rheumatoid arthritis have an increased risk for accelerated arthrosclerosis. It is not known, however, whether this disorder is associated with a higher risk of complications after coronary artery revascularization.Methods: We conducted a cross-sectional study of patients in the 2003-2005 Nationwide Inpatient Sample. To determine whether patients with rheumatoid arthritis had higher in-hospital mortality after coronary artery revascularization, we used logistic regression to adjust for age, sex, race/ethnicity, income, rural-urban residency, diabetes, hypertension, hyperlipidemia, Charlson comorbidities (including myocardial infarction, congestive heart failure, and diabetes), elective admission, weekend admission, and primary payer.Results: Among patients undergoing coronary artery revascularization, those with rheumatoid arthritis were 49% less likely to die while hospitalized compared with those without rheumatoid arthritis (odds ratio, 0.51; 95% confidence interval, 0.40-0.65) after adjusting for the above confounders. In subgroup analyses that adjusted for the same confounders, patients with rheumatoid arthritis also had a 61% improvement of in-patient mortality when they underwent percutaneous coronary interventions (odds ratio, 0.39; 95% confidence interval, 0.29-0.54) along with a median of 0.32 less days hospitalized (95% confidence interval, 0.28-0.34 days). Similarly, patients with rheumatoid arthritis undergoing coronary artery bypass grafting had a 31% improvement of in-patient mortality (odds ratio, 0.69; 95% confidence interval, 0.48-0.99), with a median of 1.36 less days hospitalized (95% confidence interval, 0.72-1.12 days).Conclusion: Among patients undergoing coronary artery revascularization, patients with rheumatoid arthritis have an in-hospital survival advantage along with reduced days of hospitalization compared with patients without rheumatoid arthritis. (J Thorac Cardiovasc Surg 2010;140:91-6)