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[BMJ圣诞特刊2018]:圣诞节及其他节假日、体育赛事和时间因素对急性心梗的影响
2018年12月29日 时讯速递, 进展交流 暂无评论

Research Christmas 2018: Heart Of The Matter

Christmas, national holidays, sport events, and time factors as triggers of acute myocardial infarction: SWEDEHEART observational study 1998-2013

    Moman A Mohammad, Sofia Karlsson, Jonathan Haddad, et al

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4811 (Published 12 December 2018)

Cite this as: BMJ 2018;363:k4811

Abstract 摘要

Objectives 目的

To study circadian rhythm aspects, national holidays, and major sports events as triggers of myocardial infarction.

研究昼夜节律、节假日及主要体育赛事对心肌梗塞的诱发作用。

Design 设计

Retrospective observational study using the nationwide coronary care unit registry, SWEDEHEART.

针对瑞典全国CCU注册研究数据库SWEDEHEART进行的回顾性观察研究

Setting 场景

Sweden.

瑞典

Participants 研究人群

283 014 cases of myocardial infarction reported to SWEDEHEART between 1998 and 2013. Symptom onset date was documented for all cases, and time to the nearest minute for 88%.

1998年至2013年间SWEDEHEART接到的283 014例心梗报告。记录所有患者的起病日期,对88%的病例记录发病时间精确到分钟。

Interventions 干预措施

Myocardial infarctions with symptom onset on Christmas/New Year, Easter, and Midsummer holiday were identified. Similarly, myocardial infarctions that occurred during a FIFA World Cup, UEFA European Championship, and winter and summer Olympic Games were identified. The two weeks before and after a holiday were set as a control period, and for sports events the control period was set to the same time one year before and after the tournament. Circadian and circaseptan analyses were performed with Sunday and 24:00 as the reference day and hour with which all other days and hours were compared. Incidence rate ratios were calculated using a count regression model.

确定圣诞节/新年、复活节及仲夏节发病的心梗病例。与此相似,记录在世界杯足球赛、欧洲冠军杯足球赛以及冬季和夏季奥运会期间发生的心梗病例。在节假日前后2周作为对照,对于体育赛事而言,将赛事前一年及后一年同一时期作为对照。分别将周日及24:00作为参照,对其他日期及时间的发病进行分析。采用计数回归模型计算发病率比值。

Main outcome measures 主要预后指标

Daily count of myocardial infarction.

每日发生心梗病例数

Results 结果

Christmas and Midsummer holidays were associated with a higher risk of myocardial infarction (incidence rate ratio 1.15, 95% confidence interval 1.12 to 1.19, P<0.001, and 1.12, 1.07 to 1.18, P<0.001, respectively). The highest associated risk was observed for Christmas Eve (1.37, 1.29 to 1.46, P<0.001). No increased risk was observed during Easter holiday or sports events. A circaseptan and circadian variation in the risk of myocardial infarction was observed, with higher risk during early mornings and on Mondays. Results were more pronounced in patients aged over 75 and those with diabetes and a history of coronary artery disease.

圣诞节与仲夏节心梗发病风险较高(发病率比值分别为 1.15,95%可信区间1.12 to 1.19, P<0.001, 以及 1.12, 1.07 to 1.18, P<0.001)。圣诞节前夜的风险最高(1.37, 1.29 to 1.46, P<0.001)。未观察到复活节或体育赛事期间发病风险升高。我们观察到心梗发病风险具有周节律及昼夜节律,风险最高的时间为早上及周一。对于年龄75岁以上、糖尿病及冠心病病史患者,风险更加突出。

Conclusions 结论

In this nationwide real world study covering 16 years of hospital admissions for myocardial infarction with symptom onset documented to the nearest minute, Christmas, and Midsummer holidays were associated with higher risk of myocardial infarction, particularly in older and sicker patients, suggesting a role of external triggers in vulnerable individuals.

这项全国性真实世界研究包括了历时16年心梗住院患者病例,且将发病时间精确到分钟。分析结果发现,圣诞节和仲夏节伴随心梗风险最高,尤其是老年及病情较重患者,提示外因对易感人群的影响。

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