背景:长期使用全身性类固醇对ST段抬高型心肌梗死(STEMI)后的电和机械并发症的影响尚未得到广泛研究。方法在2018年至2020年的国家住院患者样本(NIS)的回顾性队列研究中,根据长期(当前)全身性类固醇(LTCSS)使用的存在,对STEMI患者进行了二分。主要结果是全因死亡率。次要结果包括复合机械性并发症,电气,血液动力学,和血栓性并发症,以及血运重建的复杂性,停留时间(LOS)和总收费。多元线性和逻辑回归用于校正混杂因素。结果在608,210名STEMI患者中,5,310(0.9%)使用了LTCSS。全因死亡率(aOR:0.89,95CI:0.74-1.08,p值:0.245)和机械性并发症的组合(aOR:0.74,95CI:0.25-2.30,p值:0.599)的几率无显著差异。使用LTCSS与较低的室性心动过速相关,房室传导阻滞,新的永久性起搏器插入,心源性休克,需要机械循环支持,机械通气,心脏复律,LOS减少1天,总收费减少34,512美元(所有P值:<0.05)。血运重建策略(冠状动脉旁路移植术(CABG)与经皮冠状动脉介入治疗(PCI))或复合血栓事件的发生率。结论STEMI患者使用LTCSS与较低的电功能障碍和血流动力学不稳定的几率相关,但机械并发症的几率没有差异。CABG速率,全因死亡率,心脏骤停,或者血栓性并发症.需要进一步的前瞻性研究来进一步评估这些发现。
Background The impact of long-term systemic steroid use on electrical and mechanical complications following ST-segment elevation myocardial infarction (STEMI) has not been extensively studied. Methods In a retrospective cohort study of the National Inpatient Sample (NIS) from 2018 to 2020, adults admitted with STEMI were dichotomized based on the presence of long-term (current) systemic steroid (LTCSS) use. The primary outcome was all-cause mortality. Secondary outcomes included a composite of mechanical complications, electrical, hemodynamic, and thrombotic complications, as well as revascularization complexity, length of stay (LOS), and total charge. Multivariate linear and logistic regressions were used to adjust for confounders. Results Out of 608,210 admissions for STEMI, 5,310 (0.9%) had LTCSS use. There was no significant difference in the odds of all-cause mortality (aOR: 0.89, 95%CI: 0.74-1.08, p-value: 0.245) and the composite of mechanical complications (aOR: 0.74, 95%CI: 0.25-2.30, p-value: 0.599). LTCSS use was associated with lower odds of ventricular tachycardia, atrioventricular blocks, new permanent-pacemaker insertion, cardiogenic shock, the need for mechanical circulatory support, mechanical ventilation, cardioversion, a reduced LOS by 1 day, and a reduced total charge by 34,512 USD (all p-values: <0.05). There were no significant differences in the revascularization strategy (coronary artery bypass graft (CABG) vs. percutaneous coronary interventions (PCI)) or in the incidence of composite thrombotic events. Conclusion LTCSS use among patients admitted with STEMI was associated with lower odds of electrical dysfunction and hemodynamic instability but no difference in the odds of mechanical complications, CABG rate, all-cause mortality, cardiac arrest, or thrombotic complications. Further prospective studies are needed to evaluate these findings further.