Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis.
Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis.
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DOI：
10.1136/bmjopen-2015-007824
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发表时间：
2015-09-11
期刊：
影响因子：
2.9
通讯作者：
Quint JK
中科院分区：
文献类型：
--
作者：
Rothnie KJ;Yan R;Smeeth L;Quint JK
心血管疾病是慢性阻塞性肺疾病（COPD）患者的重要合并症。我们的目的是系统地回顾以下证据：(1)COPD患者的心肌梗死（MI）风险；(2)心肌梗死与慢性阻塞性肺病急性加重（AECOPD）相关的风险；(3)慢性阻塞性肺病患者心肌梗死后死亡风险。系统回顾和荟萃分析。检索截止到2015年1月的MEDLINE， EMBASE和SCI。两位审稿人筛选摘要和全文记录，提取数据并评估研究的偏倚风险。在可能的情况下，我们使用了通用的反方差方法来汇总效应估计。证据是在叙述性综述中合成的，不可能进行荟萃分析。搜索产生了8362条记录，包括24项观察性研究。荟萃分析显示，队列分析中心肌梗死与COPD相关的风险增加（HR 1.72, 95% CI 1.22 - 2.42），但在病例对照研究中没有：OR 1.18（0.80 - 1.76）。两项纳入的研究都调查了与AECOPD相关的心肌梗死风险，发现AECOPD后心肌梗死风险增加（发病率比，IRR 2.27, 1.10至4.70,IRR 13.04, 1.71至99.7）。荟萃分析显示，心肌梗死后住院COPD患者死亡风险增加的证据不足（OR 1.13, 0.97 - 1.31）。然而，荟萃分析显示，随访期间COPD患者心肌梗死后死亡风险增加（HR 1.26, 1.13至1.40）。有充分的证据表明，COPD与心肌梗死风险增加有关；然而，目前尚不清楚这种关联在多大程度上与吸烟状况有关。有证据表明，AECOPD期间心肌梗死的风险高于稳定期。没有证据表明慢性阻塞性肺病与心肌梗死后住院死亡率增加有关，但有充分证据表明，心肌梗死后慢性阻塞性肺病患者的长期死亡率更高。
Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD. Systematic review and meta-analysis. MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible. Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case–control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40). There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI.