背景:PTSD导致应激激素水平升高和自主神经系统失调,这可能引发心脏事件。本研究的目的是使用大型数据库评估PTSD与STEMI和NSTEMI发生之间的任何关联。
方法:使用2005年至2014年的全国住院患者样本(NIS)和ICD-9代码(n=1,621,382),我们对40岁以上有或无PTSD患者的院内STEMI和NSTEMI发生率进行了单变量卡方分析.我们还进行了多变量分析,调整了基线特征,包括年龄,性别,糖尿病,种族,高脂血症,高血压,烟草使用。
结果:2005-2014年的数据集包含401,485例STEMI患者(745例,或0.19%,PTSD)和1,219,897名NSTEMI患者(2,441名,或0.15%,PTSD)。在2005年的数据集中,0.5%的PTSD患者患有STEMI,而非PTSD患者为1.0%(OR=0.46,95%C.I.,0.36-0.59)。同样,0.6%的PTSD患者和2.2%的无PTSD患者患有NSTEMI(OR=0.28,95%C.I.,0.23-0.35)。在2014年的数据集中,0.3%的PTSD患者患有STEMI,而非PTSD患者为0.7%(OR=0.43,95%C.I.,0.35-0.51)。同样,1.4%的PTSD患者与2.9%的无PTSD患者患有NSTEMI(OR=0.48,95%C.I.,0.44-0.52)。在整个十年期间也看到了类似的趋势。在调整了年龄之后,性别,糖尿病,种族,高脂血症,高血压,和烟草的使用,PTSD与STEMI的发生率较低有关(2005:OR=0.50,95%C.I.,0.37-0.66;2014年:OR=0.35,95%C.I.,0.29-0.43)和NSTEMI(2005:OR=0.44,95%C.I.,0.34-0.57;2014年:OR=0.63,95%C.I.,0.58-0.69)。
结论:使用大型住院数据库,在诊断为PTSD的患者中,我们没有发现STEMI或NSTEMI的发生率增加,提示PTSD不是心肌梗死的独立危险因素。
BACKGROUND: PTSD leads to increased levels of stress hormones and dysregulation of the autonomic nervous system which may trigger cardiac events. The goal of this study is to evaluate any association between PTSD and the occurrence of STEMI and
NSTEMI using a large database.
METHODS: Using the Nationwide Inpatient Sample (NIS) and ICD-9 codes from 2005 to 2014 (n=1,621,382), we performed a univariate chi-square analysis of in-hospital occurrence of STEMI and
NSTEMI in patients greater than 40 years of age with and without PTSD. We also performed a multivariate analysis adjusting for baseline characteristics including age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use.
RESULTS: The 2005-2014 dataset contained 401,485 STEMI patients (745, or 0.19%, with PTSD) and 1,219,897
NSTEMI patients (2,441, or 0.15%, with PTSD). In the 2005 dataset, 0.5% of PTSD patients had STEMI compared to 1.0% of non-PTSD patients (OR=0.46, 95% C.I., 0.36-0.59). Similarly, 0.6% of patients with PTSD and 2.2% of patients without PTSD had
NSTEMI (OR=0.28, 95% C.I., 0.23-0.35). In the 2014 dataset, 0.3% of PTSD patients had STEMI compared to 0.7% of non-PTSD patients (OR=0.43, 95% C.I., 0.35-0.51). Similarly, 1.4% of patients with PTSD versus 2.9% of patients without PTSD had
NSTEMI (OR=0.48, 95% C.I., 0.44-0.52). Similar trends were seen throughout the ten-year period. After adjusting for age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use, PTSD was associated with a lower occurrence of STEMI (2005: OR=0.50, 95% C.I., 0.37-0.66; 2014: OR=0.35, 95% C.I., 0.29-0.43) and NSTEMI (2005: OR=0.44, 95% C.I., 0.34-0.57; 2014: OR=0.63, 95% C.I., 0.58-0.69).
CONCLUSIONS: Using a large inpatient database, we did not find an increased occurrence of STEMI or NSTEMI in patients diagnosed with PTSD, suggesting that PTSD is not an independent risk factor for myocardial infarction.