以健保資料庫研究泌尿道結石與急性心肌梗塞相關性
林柏宏1,2、柳瑞明3、張英勛1、馮思中1、莊正鏗1、劉忠一1
1林口長庚醫院 泌尿腫瘤科；2長庚大學 臨床醫學研究所；3衛福部桃園醫院 泌尿科
The relationship of urolithiasis and myocardial infaction: a nhird-based study
Po-Hung Lin1,2, Jui-Ming Liu3, Ying-Hsu Chang1, See-Tong Pang1, Cheng-Keng Chuang1, Chung-Yi Liu1
1Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 2Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan; 3Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Purpose:
Urolithiasis is a common disease in modern society. Several studies had revealed that urolithiasis is associated with many systemic diseases. We aimed to use the National Health Insurance Research Database (NHIRD) to investigate the relationship of urolithiasis and acute myocardial infarction (AMI).
Materials and Methods:
Patients with the diagnosis of urolithiasis (ICD-9-CM codes 592.0, 592.1, 592.9) before Jan 1, 2003 were retrieved from the NHIRD’s Longitudinal Health Insurance Database 2005 as the case group. Patients without urolithiasis were matched with 1:4 ratio regarding to sex, age and comorbidities as control group. Both groups were followed till myocardial infarction were encountered (ICD-9-CM codes 410, 411, 412, 413, 414, or 440) or till the end of 2012.
Results:
Total 37,052 cases and 148,209 controls were inducted into this study. The risk of AMI was higher among patients with urolithiasis (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.03–1.13). We detected a significant association between urinary calculi and intubation (aHR 1.53, 95% CI 1.36–1.73), intensive care unit treatment (aHR 1.22, 95% CI 1.13–1.32), heart failure (aHR 1.59, 95% CI 1.42–1.78), shock (aHR 1.53, 95% CI 1.32–1.77) and arrhythmias (aHR 1.18, 95% CI 1.06–1.33). Patients with kidney stones have the highest risk of AMI.
Conclusions:
Urolithisis is associated with higher risks of AMI and several complications of AMI. Treating urolithiasis more aggressively is recommended for patients with comorbidities related to AMI.