Long-term risk of acute coronary syndrome in patients with cholangitis: a 13-year nationwide cohort study.
OBJECTIVE
Patients with cholangitis may exhibit repeated and chronic inflammation of the biliary tract despite successful medical or surgical treatments. This nationwide cohort study examined the association between cholangitis and the subsequent development of acute coronary syndrome (ACS).


METHODS
We identified a cohort of 37676 patients who were diagnosed with cholangitis between January 1998 and December 2010, and a comparison cohort of 150704 subjects frequency matched by age, sex, and index year after excluding comorbidities for ACS. Both cohorts were followed until the end of 2010 to measure the incidence of ACS. Both incidence rate ratios and hazard ratios of ACS were estimated by age and sex.


RESULTS
Sex-specific analysis showed that males were at a higher incidence of ACS than females in both groups with (16.2 vs 11.5 per 10,000 person-years) and without (18.7 vs 12.5 per 10,000 person-years) cholangitis. The incidence of ACS also increased with age no matter having or not having cholangitis. The age stratified analysis revealed that the risk of ACS was significantly higher in patients with cholangitis younger than 65 years old. The multivariable Cox proportional hazard model demonstrated that cholangitis was significantly associated with ACS (adjusted hazard ratio [HR]=1.18; 95% confidence interval [CI], 1.03-1.35) after adjusting age and sex in the model.


CONCLUSIONS
This study suggests that patients with cholangitis are at an elevated risk of ACS. Awareness of the potential ACS risk for patients with cholangitis is important for patients and clinicians.
Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan.
Ming-Shian
MS
Tsai
Institute of Biostatistics, China Medical University, Taichung, Taiwan.
Yu-Fen
YF
Li
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Cheng-Li
CL
Lin
Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan.
Yao-Chun
YC
Hsu
Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan.
Po-Huang
PH
Lee
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Fung-Chang
FC
Sung
Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
Chia-Hung
CH
Kao
D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002761:Cholangitis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology
Acute coronary syndrome (ACS); Cholangitis; Cohort study; Taiwan National Health Insurance Research Database (NHIRD)