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The association between spinal cord injury and acute myocardial infarction in a nationwide population-based cohort
Tse-Yen Yang1, Hsuan-Ju Chen, Fung-Chang Sung
1*Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung, Taiwan †Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan ‡Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; and §Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; and ¶Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Insights
Patients diagnosed with spinal cord injury (SCI) face a higher risk of acute myocardial infarction (AMI). This highlights the need for increased cardiovascular surveillance in SCI patients.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Cardiovascular diseases are leading causes of death in spinal cord injury (SCI) patients.
- Patients with SCI have a higher mortality rate from cardiovascular diseases compared to the general population.
Purpose of the Study:
- To evaluate the risk of acute myocardial infarction (AMI) in patients newly diagnosed with SCI.
- To identify comorbidities and SCI characteristics associated with increased AMI risk.
Main Methods:
- Retrospective cohort study using Taiwan's National Health Insurance Research Database.
- 22,197 patients with SCI were compared to a control group using risk-set sampling (1:4 ratio).
- Cox proportional hazards model was used to calculate adjusted hazard ratios (aHR) for AMI.
Main Results:
- Patients with SCI had a significantly higher risk of developing AMI (aHR=1.17).
- Comorbidities like cardiovascular disease, COPD, hypertension, and renal disease increased AMI risk.
- Thoracic spine SCI was also associated with a higher risk of AMI.
Conclusions:
- Patients with SCI exhibit an elevated risk of AMI.
- Findings emphasize the importance of surveillance and risk factor modification for AMI in SCI patients.
Study Design:
A spinal cord injury (SCI) retrospective cohort study was derived from the National Health Insurance Research Database of Taiwan.
Objective:
We evaluated risk of acute myocardial infarction (AMI) in patients newly diagnosed with SCI.
Summary Of Background Data:
According to information of the World Health Organization, cardiovascular diseases are the most frequent causes of death in patients with SCI compared with those in the general population.
Methods:
We obtained claims data from the National Health Insurance Research Database for this cohort study. The SCI group comprised 22,197 patients with a diagnosis of SCI. Case and control patients were based on risk-set sampling in a 1:4 ratio, and we excluded patients with a prior diagnosis of AMI. Comorbidities were categorized as the proportion of prior illnesses in the SCI and non-SCI groups. We used the Cox proportion model to explore adjusted hazard ratio (aHR) for developing AMI between case and control patients.
Results:
Patients with SCI were significantly more likely to exhibit pre-existing illnesses associated with AMI than patients without SCI. Patients with a diagnosis of SCI exhibited significantly higher aHRs for developing AMI than patients without SCI (aHR=1.17; P<0.05). Patients with SCI, compared with patients without SCI, were associated with a subsequent AMI risk (aHR=1.17; P<0.05). Several comorbidities, such as cardiovascular disease (aHR=1.29; P<0.05), chronic obstructive pulmonary disease (aHR=1.51; P<0.05), hypertension (aHR=1.34; P<0.01), and renal disease (aHR=1.76; P<0.05), were associated with an increased AMI risk. Furthermore, T-spine SCI was significantly associated with an AMI risk (aHR=1.38; P<0.05).
Conclusion:
Patients with as diagnosis of SCI exhibited an increased risk of AMI compared with patients without SCI. These findings have broad implications for surveillance among patients with SCI, and future studies should evaluate whether risk factor modification can decrease AMI risk among patients with SCI.
Level Of Evidence:
3.
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