The association between spinal cord injury and acute myocardial infarction in a nationwide population-based cohort study.
METHODS
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.


BACKGROUND
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).


CONCLUSIONS
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.


METHODS
3.
*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.
Tse-Yen
TY
Yang
Hsuan-Ju
HJ
Chen
Fung-Chang
FC
Sung
Chia-Hung
CH
Kao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology