1
|
Borhani-Haghighi A, Hooshmandi E, Zahediasl F, Molavi Vardanjani H, Rezaei M, Rahimi-Jaberi A, Ashjazadeh N, Petramfar P, Ostovan VR, Fadakar N, Poursadeghfard M, Izadi S, Nazeri M, Zafarmand SS, Bayat M, Salehi MS, Owjfard M, Sedighi B, Iranmanesh F, Shafiei K, Vakilian A, Moghadam Ahmadi A, Nemati R, Rezaeian Jahromi F, Jalalijahromi M, Kashani K, Razmeh S, Bahrehbar M, Basir M, Qureshi AI. Early and mid-term outcomes of carotid angioplasty and stent placement in 579 patients. J Neuroimaging 2022; 32:1161-1169. [PMID: 35969379 DOI: 10.1111/jon.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid-term complications associated with CAS. METHODS This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All-cause mortality, vascular mortality, and stroke were investigated during mid-term follow-up. RESULTS A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p = .048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p = .041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all-cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All-cause mortality was significantly higher among patients with symptomatic carotid stenosis (p = .014). CONCLUSION CAS provides acceptable short-term and mid-term outcomes in a unique population of high- and standard-surgical-risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients.
Collapse
Affiliation(s)
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Zahediasl
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Molavi Vardanjani
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdiyeh Rezaei
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimi-Jaberi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Reza Ostovan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Fadakar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Nazeri
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahnaz Bayat
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Saied Salehi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Owjfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnaz Sedighi
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Farhad Iranmanesh
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Kaveh Shafiei
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Alireza Vakilian
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amir Moghadam Ahmadi
- Neuro-immunology Research Scholar, Thomas Jefferson University, Philadelphia, PA, USA
| | - Reza Nemati
- Department of Neurology, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | | | - Kaveh Kashani
- Department of Neurology, Fasa University of Medical Sciences, Fasa, Iran
| | - Saeed Razmeh
- Department of Neurology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mansour Bahrehbar
- Department of Neurology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Marzieh Basir
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
2
|
Tsai MS, Chen HC, Li HY, Tsai YT, Yang YH, Liu CY, Lee YC, Hsu CM, Lee LA. Sleep Apnea and Risk of Influenza-Associated Severe Acute Respiratory Infection: Real-World Evidence. Nat Sci Sleep 2022; 14:901-909. [PMID: 35586456 PMCID: PMC9109977 DOI: 10.2147/nss.s346984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We executed the presented retrospective cohort study with the purpose of probing the risk of severe acute respiratory infection (SARI) following influenza in patients with sleep apnea. MATERIALS AND METHODS We executed this real-world study by gathering Taiwan National Health Insurance Research Database (NHIRD) data. From a database containing 1 million individuals sampled at random from the NHIRD, we identified all patients aged 20 years or older with a sleep apnea diagnosis between 1997 and 2013 as the study group. We established a comparison cohort of individuals without sleep apnea by randomly matching patients with respect to monthly income, gender, urbanization level, and age at a 1:4 ratio. Follow-up was performed until death or the end of 2015 for both groups. We determined the study outcome to be the occurrence of influenza-associated SARI. RESULTS We enrolled 6508 and 26,032 patients into the study and comparison groups, respectively. A significantly higher cumulative incidence of influenza-associated SARI was discovered in the study group (p < 0.001). In our multivariate analysis, sleep apnea, chronic obstructive pulmonary disease, and coronary artery disease were independent risk factors for influenza-associated SARI. The hazard ratio of sleep apnea for influenza-associated SARI was 1.98 (95% CI: 1.26-3.10) after adjustment for all comorbidities, gender, age, monthly income, and urbanization level. CONCLUSION Sleep apnea increased the risk of influenza-associated SARI. We suggest that physicians be cautious about the development of severe influenza illness in patients with sleep apnea. Vaccination and early oseltamivir administration should be actively considered in this group of patients.
Collapse
Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, 613, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
| | - Hung-Chin Chen
- Department of Otolaryngology - Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
| | - Hsueh-Yu Li
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Otolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, 613, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, 613, Taiwan.,Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, 613, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
| | - Yi-Chan Lee
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Otolaryngology - Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology - Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, 613, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Li-Ang Lee
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Otolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, 300, Taiwan
| |
Collapse
|
3
|
Lu YT, Hsin CH, Lu YC, Wu MC, Huang JY, Huang CC, Wang PH, Yang SF. Risk of head and neck cancer in patients with peptic ulcers and the effect of Helicobacter pylori treatment. Sci Rep 2021; 11:6229. [PMID: 33737604 PMCID: PMC7973765 DOI: 10.1038/s41598-021-85598-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 02/22/2021] [Indexed: 12/22/2022] Open
Abstract
It remained inconclusive whether patients with peptic ulcer disease had a higher risk of head and neck cancer (HNC). Therefore, we enrolled 109,360 patients with peptic ulcer disease and matched for age and sex with 218,720 controls from the Taiwan National Health Insurance Research Database between January 1, 1997 and December 31, 2013.The HNC incidence rate was 1.33-fold higher in the peptic ulcer group than in the control group (7.52 vs. 5.68 per 100,00 person-years; crude relative risk: 1.33; 95% confidence interval [CI]: 1.08–1.63) after > 6 years of follow-up. However, in the peptic ulcer subgroup with H. pylori treatment, HNC risk was not significantly different from that of the control group (crude relative risk: 1.12; 95% CI: 0.86–1.46). Moreover, the population with peptic ulcers had the highest risk of laryngeal and hypopharyngeal cancer (adjusted HR: 2.27 [95% CI: 1.16–4.44] and 2.00 [95% CI, 1.13–3.55]), respectively. This observational study suggested that peptic ulcer disease is associated with an increased incidence of laryngeal and hypopharyngeal cancer and H. pylori treatment may have a role in preventing HNC in patients with peptic ulcer disease.
Collapse
Affiliation(s)
- Yen-Ting Lu
- Department of Otolaryngology, St. Martin De Porres Hospital, Chiayi, Taiwan.,Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung City, 40201, Taiwan
| | - Chung-Han Hsin
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung City, 40201, Taiwan
| | - Ying-Chou Lu
- Department of Otolaryngology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Meng-Che Wu
- Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung City, 40201, Taiwan.,Division of Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung City, 40201, Taiwan.,Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chen Huang
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung City, 40201, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung City, 40201, Taiwan. .,Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung City, 40201, Taiwan. .,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
4
|
Lu Y, Lu Y, Cheng H, Hsin C, Yang S, Wang P, Yeh H. Chronic rhinosinusitis after radiotherapy in patients with head and neck cancer: a population‐based cohort study in Taiwan. Int Forum Allergy Rhinol 2020; 10:692-697. [DOI: 10.1002/alr.22526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Yen‐Ting Lu
- Department of OtolaryngologySt. Martin De Porres Hospital Chiayi Taiwan
- Department of OtolaryngologyChung Shan Medical University Hospital Taichung Taiwan
- Institute of MedicineChung Shan Medical University Taichung Taiwan
| | - Ying‐Chou Lu
- Department of OtolaryngologySt. Martin De Porres Hospital Chiayi Taiwan
| | - Hui‐Chen Cheng
- Department of OphthalmologyTaipei Veterans General Hospital Taipei Taiwan
- Department of Ophthalmology, School of MedicineNational Yang‐Ming University Taipei Taiwan
- Program in Molecular Medicine, School of Life SciencesNational Yang‐Ming University Taipei Taiwan
- Department of Life Sciences and Institute of Genome Sciences, School of Life SciencesNational Yang‐Ming University Taipei Taiwan
| | - Chung‐Han Hsin
- Department of OtolaryngologyChung Shan Medical University Hospital Taichung Taiwan
- Institute of MedicineChung Shan Medical University Taichung Taiwan
| | - Shun‐Fa Yang
- Institute of MedicineChung Shan Medical University Taichung Taiwan
- Department of Medical ResearchChung Shan Medical University Hospital Taichung Taiwan
| | - Po‐Hui Wang
- Institute of MedicineChung Shan Medical University Taichung Taiwan
- Department of Obstetrics and GynecologyChung Shan Medical University Hospital Taichung Taiwan
| | - Huan‐Jui Yeh
- Department of Physical Medicine and RehabilitationTaoyuan General Hospital Ministry of Health and Welfare Taoyuan Taiwan
- Institute of Public HealthNational Yang‐Ming University Taipei Taiwan
| |
Collapse
|
5
|
Tsai MS, Chang GH, Chen WM, Liu CY, Lin MH, Chang PJ, Huang TY, Tsai YT, Wu CY, Hsu CM, Yang YH. The Association Between Decompensated Liver Cirrhosis and Deep Neck Infection: Real-World Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203863. [PMID: 31614776 PMCID: PMC6843924 DOI: 10.3390/ijerph16203863] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deep neck infection (DNI) can progress to become a life-threatening complication. Liver cirrhosis, which is related to poor immune conditions, is a likely risk factor for DNI. This study investigated the risk and mortality of DNI in patients with decompensated liver cirrhosis (DLC). METHODS We performed a nationwide cohort study using the National Health Insurance Research Database (NHIRD) in Taiwan. We included a total of 33,175 patients with DLC between 2000 and 2013, from the Catastrophic Illness Patient Database, a subsection of the NHIRD, along with 33,175 patients without cirrhosis who were matched in a 1:1 proportion for age, sex, and socioeconomic status. The occurrence of DNI was the primary study outcome. The risk, treatment, and mortalities of DNI were evaluated in the study and comparison cohorts. RESULTS DLC Patients had a significantly higher incidence of DNI than noncirrhotic patients (p < 0.001). The adjusted Cox proportional hazard regression showed that DLC was associated with a significantly higher risk of DNI (adjusted hazard ratio, 4.11; 95% confidence interval, 3.16-5.35, p < 0.001). The mortality rate in cirrhotic patients with DNI was not significantly higher than that in noncirrhotic patients with DNI (11.6% vs. 9.8%; p = 0.651). CONCLUSIONS This study is the first to investigate the correlation between DLC and DNI. The study findings strongly indicate that DLC is an independent risk factor for DNI. Cirrhotic patients with DNI do not have a significantly poorer survival rate than noncirrhotic patients with DNI. Therefore, physicians should be alert to potential DNI occurrence in DLC patients. Besides this, intensive care and appropriate surgical drainage can yield similar survival outcomes in DLC-DNI and noncirrhosis-DNI patients.
Collapse
Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Wei-Ming Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Tsung-Yu Huang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Ching-Yuan Wu
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| |
Collapse
|
6
|
Vonesh E, Gooch KL, Khangulov V, Schermer CR, Johnston KM, Szabo SM, Rumsfeld JS. Cardiovascular risk profile in individuals initiating treatment for overactive bladder - Challenges and learnings for comparative analysis using linked claims and electronic medical record databases. PLoS One 2018; 13:e0205640. [PMID: 30325968 PMCID: PMC6191128 DOI: 10.1371/journal.pone.0205640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/28/2018] [Indexed: 11/19/2022] Open
Abstract
For managing overactive bladder (OAB), mirabegron, a β3 adrenergic receptor agonist, is typically used as second-line pharmacotherapy after antimuscarinics. Therefore, patients initiating treatment with mirabegron and antimuscarinics may differ, potentially impacting associated clinical outcomes. When using observational data to evaluate real-world safety and effectiveness of OAB treatments, residual bias due to unmeasured confounding and/or confounding by indication are important considerations. Falsification analysis, in which clinically irrelevant endpoints are tested as a reference, can be used to assess residual bias. The objective in this study was to compare baseline cardiovascular risk among OAB patients by treatment, and assess the presence of residual bias via falsification analysis of OAB patients treated with mirabegron or antimuscarinics, to determine whether clinically relevant comparisons across groups would be feasible. Linked electronic health record and claims data (Optum/Humedica) for OAB patients in the United States from 2011-2015 were available, with index defined as first date of OAB treatment during this period. Unadjusted characteristics were compared across groups at index and propensity-matching conducted. Falsification endpoints (hepatitis C, shingles, community-acquired pneumonia) were compared between groups using odds ratios (ORs) and 95% confidence intervals (CI). The study identified 10,311 antimuscarinic- and 408 mirabegron-treated patients. Mirabegron patients were predominantly older males, with more comorbidities. The analytic sample included 1,188 antimuscarinic patients propensity-matched to 396 mirabegron patients; after matching, no significant baseline differences remained. Estimates of falsification ORs were 0.7 (CI:0.3-1.7) for shingles, 1.5 (CI:0.3-8.2) for hepatitis C, 0.8 (CI:0.4-1.8) and 0.9 (CI:0.6-1.4) for pneumonia. While propensity matching successfully balanced observed covariates, wide CIs prevented definitive conclusions regarding residual bias. Accordingly, further observational comparisons by treatment group were not pursued. In real-world analysis, bias-detection methods could not confirm that differences in cardiovascular risk in patients receiving mirabegron versus antimuscarinics were fully adjusted for, precluding clinically relevant comparisons across treatment groups.
Collapse
Affiliation(s)
- E. Vonesh
- Department of Biostatistics, Northwestern Medicine, Chicago, IL, United States of America
| | - K. L. Gooch
- Medical Affairs, Astellas Pharma USA, Northbrook, IL, United States of America
| | - V. Khangulov
- Boston Strategic Partners, Boston, MA, United States of America
| | - C. R. Schermer
- Medical Affairs, Astellas Pharma USA, Northbrook, IL, United States of America
| | | | | | - J. S. Rumsfeld
- Faculty of Medicine, University of Colorado, Denver, CO, United States of America
| |
Collapse
|
7
|
An artificial neural network model for the evaluation of carotid artery stenting prognosis using a national-wide database. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:2566-2569. [PMID: 29060423 DOI: 10.1109/embc.2017.8037381] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stroke is a serious health problem in many countries. About 20% of ischemia stroke involves carotid stenosis. Neck carotid ultrasound is fast, secure and convenient way to detect carotid artery stenosis. Carotid artery stenting (CAS) has become a popular treatment for cerebrovascular stenosis in recent years. However, CAS may also induce the occurrence of major adverse cardiovascular events (MACE) in older patients. Hence the evaluation the CAS prognosis is important. In this study, we attempted to construct a model for the evaluation of CAS prognosis by artificial neural network (ANN). The data of 317 patients from Taiwan Nation Health Insurance Research Database (NHIRD) was used to train and test the constructed ANN model. The input features contain 13 clinical risk factors and the output is the occurrence of MACE. In results, an ANN model of multilayer perceptron with 18 neurons in hidden layer was developed. The performance of this model is with sensitivity 89.4%, specificity 57.4%, and accuracy 82.5% in testing group as well as with sensitivity 85.8%, specificity 60.8% and accuracy 80.76% in overall patients. The results revealed that the created ANN model achieved a good performance in prediction of MACE in patients needing CAS treatment. Such a model will be helpful for prevention of high-risked patients with CAS and could serve as a reference of communication when neurologists refer patients and before patients are treated by cardiologists.
Collapse
|
8
|
Tsai MS, Lee LA, Tsai YT, Yang YH, Liu CY, Lin MH, Hsu CM, Chen CK, Li HY. Sleep apnea and risk of vertigo: A nationwide population-based cohort study. Laryngoscope 2017; 128:763-768. [PMID: 28771753 DOI: 10.1002/lary.26789] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the risk of vertigo in patients with sleep apnea. STUDY DESIGN Retrospective cohort study. METHODS This study used data from the National Health Insurance Research Database of Taiwan, a population-based database. A total of 5,025 patients who were newly diagnosed with sleep apnea between January 1, 1997, and December 31, 2012, were identified from the Longitudinal Health Insurance Database 2000, a nationally representative database of 1 million randomly selected patients. Moreover, 20,100 patients without sleep apnea were matched at a 1:4 ratio by age, sex, socioeconomic status, and urbanization level. Patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of vertigo. RESULTS Patients with sleep apnea had a significantly higher cumulative incidence of vertigo than those without sleep apnea (P < 0.001). The adjusted Cox proportional hazard model showed that sleep apnea was significantly associated with a higher incidence of vertigo (hazard ratio, 1.71; 95% confidence interval [CI], 1.48-1.97; P < 0.001). Sensitivity and subgroup analyses were performed to adjust for confounders, including head trauma, diabetes mellitus, hypertension, stroke, and obesity. Sleep apnea was demonstrated to be an independent risk factor for vertigo. CONCLUSION This is the first nationwide population-based cohort study to investigate the association between sleep apnea and vertigo. The findings strongly support that sleep apnea is an independent risk factor for vertigo. Based on the study results, physicians should be aware of potential vertigo occurrence following sleep apnea. LEVEL OF EVIDENCE 4. Laryngoscope, 128:763-768, 2017.
Collapse
Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.,Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
| | - Li-Ang Lee
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
| | - Yao-Hsu Yang
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.,Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan, Republic of China
| | - Chia-Yen Liu
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
| | - Meng-Hung Lin
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
| | - Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Hsueh-Yu Li
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| |
Collapse
|
9
|
Hung CS, Yeh CF, Lin MS, Chen YH, Huang CC, Li HY, Kao HL. Impact of hospital volume on long-term neurological outcome in patients undergoing carotid artery stenting. Catheter Cardiovasc Interv 2017; 89:1242-1249. [PMID: 28296028 DOI: 10.1002/ccd.26989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 01/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The impact of hospital volume on long-term outcome after carotid artery stenting (CAS) remains unknown. OBJECTIVES We designed a nationwide cohort study to elucidate the impact of hospital volume on the incidence of stroke after CAS. METHODS The Taiwan National Health Insurance Research database was used to identify all patients admitted for CAS from 2008 to 2012. We defined high-volume hospitals as those performing more than 20 CAS per year. The primary outcome was new ischemic stroke after discharging from the index CAS. Propensity score-matching was performed to create two matched groups for comparison. RESULTS A total of 3,248 patients underwent 3,576 CAS procedures were enrolled. There were 56 hospitals performing CAS during the study period. Among these 3,248 patients, 2,226 (68.5%) were performed in high-volume hospitals. A propensity score-matching created two groups with 1,000 patients in each group. During a median of 2.06 years follow-up, 35 (3.5%) and 52 (5.2%) patients in high-volume hospitals and low-volume hospitals developed new ischemic stroke 30 days after discharging from the index CAS, respectively (for low-volume hospitals, HR 1.50, 95%CI 1.06-2.12, P = 0.023). The use of embolic protection device did not result in different periprocedural or postdischarge strokes. The periprocedural (within 30 days after CAS) ischemic stroke or all-cause mortality rates during follow-up period were similar between two groups. CONCLUSIONS CAS performed in high-volume hospitals was associated with less new ischemic stroke after discharging from the index CAS, compared to those in low-volume hospitals. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
10
|
Sun D, Yang F. Metformin improves cardiac function in mice with heart failure after myocardial infarction by regulating mitochondrial energy metabolism. Biochem Biophys Res Commun 2017; 486:329-335. [PMID: 28302481 DOI: 10.1016/j.bbrc.2017.03.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/11/2017] [Indexed: 12/20/2022]
Abstract
To investigate whether metformin can improve the cardiac function through improving the mitochondrial function in model of heart failure after myocardial infarction. Male C57/BL6 mice aged about 8 weeks were selected and the anterior descending branch was ligatured to establish the heart failure model after myocardial infarction. The cardiac function was evaluated via ultrasound after 3 days to determine the modeling was successful, and the mice were randomly divided into two groups. Saline group (Saline) received the intragastric administration of normal saline for 4 weeks, and metformin group (Met) received the intragastric administration of metformin for 4 weeks. At the same time, Shame group (Sham) was set up. Changes in cardiac function in mice were detected at 4 weeks after operation. Hearts were taken from mice after 4 weeks, and cell apoptosis in myocardial tissue was detected using TUNEL method; fresh mitochondria were taken and changes in oxygen consumption rate (OCR) and respiratory control rate (RCR) of mitochondria in each group were detected using bio-energy metabolism tester, and change in mitochondrial membrane potential (MMP) of myocardial tissue was detected via JC-1 staining; the expressions and changes in Bcl-2, Bax, Sirt3, PGC-1α and acetylated PGC-1α in myocardial tissue were detected by Western blot. RT-PCR was used to detect mRNA levels in Sirt3 in myocardial tissues. Metformin improved the systolic function of heart failure model rats after myocardial infarction and reduced the apoptosis of myocardial cells after myocardial infarction. Myocardial mitochondrial respiratory function and membrane potential were decreased after myocardial infarction, and metformin treatment significantly improved the mitochondrial respiratory function and mitochondrial membrane potential; Metformin up-regulated the expression of Sirt3 and the activity of PGC-1α in myocardial tissue of heart failure after myocardial infarction. Metformin decreases the acetylation level of PGC-1α through up-regulating Sirt3, mitigates the damage to mitochondrial membrane potential of model of heart failure after myocardial infarction and improves the respiratory function of mitochondria, thus improving the cardiac function of mice.
Collapse
Affiliation(s)
- Dan Sun
- Department of Geriatrics, General Hospital of Daqing Oil Field, Daqing City, China.
| | - Fei Yang
- Department of Geriatrics, General Hospital of Daqing Oil Field, Daqing City, China
| |
Collapse
|
11
|
Chang LH, Lin LY, Tsai MT, How CK, Chiang JH, Hsieh VCR, Hu SY, Hsieh MS. Association between hyperglycaemic crisis and long-term major adverse cardiovascular events: a nationwide population-based, propensity score-matched, cohort study. BMJ Open 2016; 6:e012233. [PMID: 27554106 PMCID: PMC5013487 DOI: 10.1136/bmjopen-2016-012233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Hyperglycaemic crisis was associated with significant intrahospital morbidity and mortality. However, the association between hyperglycaemic crisis and long-term cardiovascular outcomes remained unknown. This study aimed to investigate the association between hyperglycaemic crisis and subsequent long-term major adverse cardiovascular events (MACEs). PARTICIPANTS AND METHODS This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database for the period of 1996-2012. A total of 2171 diabetic patients with hyperglycaemic crisis fit the inclusion criteria. Propensity score matching was used to match the baseline characteristics of the study cohort to construct a comparison cohort which comprised 8684 diabetic patients without hyperglycaemic crisis. The risk of long-term MACEs was compared between the two cohorts. RESULTS Six hundred and seventy-six MACEs occurred in the study cohort and the event rate was higher than that in the comparison cohort (31.1% vs 24.1%, p<0.001). Patients with hyperglycaemic crisis were associated with a higher risk of long-term MACEs even after adjusting for all baseline characteristics and medications (adjusted HR=1.76, 95% CI 1.62 to 1.92, p<0.001). Acute myocardial infarction had the highest adjusted HR (adjusted HR=2.19, 95% CI 1.75 to 2.75, p<0.001) in the four types of MACEs, followed by congestive heart failure (adjusted HR=1.97, 95% CI 1.70 to 2.28, p<0.001). Younger patients with hyperglycaemic crisis had a higher risk of MACEs than older patients (adjusted HR=2.69 for patients aged 20-39 years vs adjusted HR=1.58 for patients aged >65 years). CONCLUSIONS Hyperglycaemic crisis was significantly associated with long-term MACEs, especially in the young population. Further prospective longitudinal study should be conducted for validation.
Collapse
Affiliation(s)
- Li-Hsin Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Yu Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chorng-Kuang How
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jen-Huai Chiang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University, Taichung, Taiwan
| | - Vivian Chia-Rong Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Ming-Shun Hsieh
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| |
Collapse
|
12
|
Abstract
Because stroke is the third leading disease that causes mortality in the world, the prevention of stroke from advanced carotid stenosis is an important issue. The carotid stent (CAS) is a less invasive to treat advanced carotid stenosis, but for high-risk patients it may cause some events after the procedure that reduces the benefit of stroke prevention. Because patients and their families have less information about risk of events after CAS and are easy concerned, this study calculates the individual probability of major adverse cardiovascular events including any stroke, myocardial infarction, or death after procedure.The analyzed dataset was composed of patients undergoing CAS from the longitudinal National Health Insurance claim database in Taiwan. The validation dataset was composed of patients undergoing CAS from the Tri-Service General Hospital. We excluded patients under 18 years of age. The prediction model was constructed with a multivariable Cox proportional hazard regression and performed with forward stepwise selection. The nomogram construction was based on the multivariable Cox model.The risk factors were determined as follows: age with a hazard ratio (HR) of 1.027 (95% confidence interval [CI]: 1.002-1.053) for every 1 year older, congestive heart failure with a HR of 2.196 (95% CI: 1.368-3.524), malignant disease with a HR of 1.724 (95% CI: 1.009-2.944), diabetes mellitus with a HR of 1.722 (95% CI: 1.109-2.674), and symptomatic status with a HR of 1.604 (95% CI: 1.027-2.507). The model showed good discrimination with a P < 0.001 (concordance index, 0.681; bootstrap corrected, 0.661) in the derivation data. The concordance index of external validation was 0.66 (P = 0.048), which indicates acceptable performance.We developed a nomogram with a visual scale method and prognostic information, and it is easy to use in clinical practice. The integer-base method may support communication between clinicians and patients before CAS to reduce the anxiety about making a treatment decision. However, insofar as older patients with multiple comorbidities are at high risk, the option of an alternative treatment strategy with medical therapy should be suggested. In the future, prospective tests should be performed to validate whether this model helps patients to prevent events.
Collapse
Affiliation(s)
- Chun-An Cheng
- Graduate Institute of Biomedical Informatics, Taipei Medical University
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center
- School of Public Health, National Defense Medical Center
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Hui-Chen Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, Taipei Medical University
- Correspondence: Hung-Wen Chiu, Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei 110, Taiwan, ROC (e-mail: )
| |
Collapse
|
13
|
Arif S, Wojtasik J, Dziewierz A, Bartuś K, Dudek D, Bartuś S. Long-term mortality and follow-up after carotid artery stenting. Hippokratia 2016; 20:204-208. [PMID: 29097886 PMCID: PMC5654437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Carotid artery stenting (CAS) is an alternative to carotid endarterectomy for the prevention of stroke and transient ischemic attack (TIA). The high long-term mortality among patients who underwent CAS seems to be related to the high comorbidity burden, including coronary and peripheral artery disease. However, limited data on very long-term mortality (over four years) and predictors of death are available. AIM We sought to investigate the very long-term survival after CAS and the impact of comorbidities on mortality at follow-up. METHODS Data of 194 symptomatic and asymptomatic patients who underwent CAS with cerebral protection systems from December 2002 to March 2014 were analyzed. All cause mortality during long-term follow-up was assessed. Univariate and multivariate Cox regression analysis was used to find independent predictors of death. RESULTS The median age of patients was 66 [interquartile range (IQR): 60-73] years and 78.9 % of patients were male. The median follow-up was 7.6 (IQR: 4.4-10.2) years. The all-cause mortality rate after 30 days, one year, four years, and at maximum follow-up was 0 %, 5.1 %, 17.5 % and 31.4 %, respectively. Out of 61 deaths, 37 (60 %) were cardio-cerebral vascular related deaths, 15 (25 %) non-cardiovascular deaths, and 9 (15 %) due to unknown reasons. Among cardio-cerebral vascular deaths, there were 12 fatal strokes, 18 fatal myocardial infarctions and seven other cardiac related deaths. Non-cardiac deaths were due mainly to cancer (9/15). Age and diabetes mellitus were independent predictors of all-cause death during long-term follow-up. CONCLUSIONS The mortality rate during short and long-term follow-up after CAS was lower than reported in the literature. Age and diabetes mellitus were independent predictors of all-cause death. Further research is needed to confirm the potential association between those risk factors and decreased survival. Hippokratia 2016, 20(3): 204-208.
Collapse
Affiliation(s)
- S Arif
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - J Wojtasik
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - A Dziewierz
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - K Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - D Dudek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - S Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| |
Collapse
|
14
|
Odutayo A, Wong CX, Farkouh M, Altman DG, Hopewell S, Emdin CA, Hunn BH. AKI and Long-Term Risk for Cardiovascular Events and Mortality. J Am Soc Nephrol 2016; 28:377-387. [PMID: 27297949 DOI: 10.1681/asn.2016010105] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/21/2016] [Indexed: 12/11/2022] Open
Abstract
AKI associates with increased long-term risk of mortality, but the prognostic significance of AKI in terms of long-term cardiovascular disease remains unconfirmed. We conducted a systematic review and meta-analysis to assess whether AKI associates with long-term cardiovascular disease. We included cohort studies that examined adults with and without AKI and reported a multivariable-adjusted relative risk (RR) for the association between AKI and cardiovascular mortality, major cardiovascular events, and disease-specific events: congestive heart failure, acute myocardial infarction, and stroke. Twenty-five studies involving 254,408 adults (55,150 with AKI) were included. AKI associated with an 86% and a 38% increased risk of cardiovascular mortality and major cardiovascular events, respectively ([RR 1.86; 95% confidence interval (95% CI), 1.72 to 2.01] and [RR 1.38; 95% CI, 1.23 to 1.55], respectively). For disease-specific events, AKI associated with a 58% increased risk of heart failure (RR 1.58; 95% CI, 1.46 to 1.72) and a 40% increased risk of acute myocardial infarction (RR 1.40; 95% CI, 1.23 to 1.59). The elevated risk of heart failure and acute myocardial infarction persisted in subgroup analyses on the basis of AKI severity and the proportion of adults with baseline ischemic heart disease. Finally, AKI was associated with a 15% increased risk of stroke (RR 1.15; 95% CI, 1.03 to 1.28). In conclusion, AKI associates with an elevated risk of cardiovascular mortality and major cardiovascular events, particularly heart failure and acute myocardial infarction.
Collapse
Affiliation(s)
- Ayodele Odutayo
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; .,Centre for Statistics in Medicine
| | | | - Michael Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada; and
| | | | | | | | - Benjamin H Hunn
- School of Medicine, University of Tasmania, Hobart, Australia.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| |
Collapse
|