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Risk Assessment of Major Adverse Cardiovascular and Cerebrovascular Events and Bleeding for Acute Myocardial Infarction With or Without Active Tuberculosis

  • Author Footnotes
    # These authors contributed equally to this work.
    Xiaoqun Xu
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Houyong Zhu
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Long Cai
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Libin Liu
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Fengwei Zhang
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Hongjuan Zhou
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Bin Mei
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Mingzhi Zhu
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Lingshan Dai
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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  • Tielong Chen
    Correspondence
    Address correspondence to: Tielong Chen, No. 453 Stadium Road, Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, China;
    Affiliations
    Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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  • Kan Xu
    Correspondence
    Address correspondence to: Kan Xu, NO. 208 East Huancheng Road, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;
    Affiliations
    Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
Published:September 20, 2022DOI:https://doi.org/10.1016/j.clinthera.2022.08.011

      Abstract

      Purpose

      The underlying ischemic and bleeding risks of acute myocardial infarction (AMI) with active tuberculosis (TB) are unknown. The goal of this study was to explore the ischemic and bleeding risks, as well as treatment strategies during hospitalization, in patients with AMI with or without active TB.

      Methods

      Patients were recruited from a tuberculosis hospital from 2014 to 2021. The primary outcomes were major cardiovascular and cerebrovascular events (MACE) and Bleeding Academic Research Consortium (BARC)-defined type 3 or 5 bleeding. Multivariate logistic regression and propensity score matching were performed for risk adjustment. Subgroups were defined according to AMI with active pulmonary TB and AMI with active TB undergoing percutaneous coronary intervention (PCI).

      Findings

      A total of 242 patients were enrolled. Compared with AMI without active TB, AMI with active TB had a higher risk of MACE and BARC type 3 or 5 bleeding (P < 0.001 and P = 0.002, respectively). Multivariate logistic regression analysis showed that, compared with AMI without active TB, the odds ratio (OR) was 6.513 (95% CI, 2.195–19.331) for MACE in patients with AMI with active TB, and the OR was 16.074 (95% CI 3.337–77.436) for BARC type 3 or 5 bleeding in patients with AMI with active TB. After propensity score matching, AMI with active TB tended to increase the risk of MACE, although not statistically significantly (P = 0.189), and increased BARC type 3 or 5 bleeding (P < 0.001), compared with AMI without active TB. Results of subgroup analyses showed that active TB had outcomes consistent with those of the total cohort. AMI patients with active pulmonary TB who underwent PCI had a lower risk of MACE without an increase in the risk of bleeding compared with those not undergoing PCI.

      Implications

      Patients with AMI with active TB have a higher risk of MACE (or severe MACE) and bleeding than patients with AMI without active TB. However, AMI patients with active TB are still advised to undergo PCI for a high net clinical benefit.

      Keywords

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      References

      1. World Health Organization Global Tuberculosis Report. 2020. Available online: https://apps.who.int/iris/bitstream/handle/10665/336069/9789240013131-eng.pdf.

        • Gulati R
        • Behfar A
        • Narula J
        • et al.
        Acute myocardial infarction in young individuals.
        Mayo Clin Proc. 2020; 95: 136-156
        • Shibata T
        • Kawakami S
        • Noguchi T
        • et al.
        Prevalence, clinical features, and prognosis of acute myocardial infarction attributable to coronary artery embolism.
        Circulation. 2015; 132: 241-250
        • Jacoby RM
        • Nesto RW.
        Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis.
        J Am Coll Cardiol. 1992; 20: 736-744
        • Huaman MA
        • Kryscio RJ
        • Fichtenbaum CJ
        • et al.
        Tuberculosis and risk of acute myocardial infarction: a propensity score-matched analysis.
        Epidemiol Infect. 2017; 145: 1363-1367
        • Huaman MA
        • Ticona E
        • Miranda G
        • et al.
        The relationship between latent tuberculosis infection and acute myocardial infarction.
        Clin Infect Dis. 2018; 66: 886-892
        • Yew WW
        • Chang KC
        • Chan DP.
        Oxidative stress and first-line antituberculosis drug-induced hepatotoxicity.
        Antimicrob Agents Chemother. 2018; 62: e02617-e02637
        • Forget EJ
        • Menzies D.
        Adverse reactions to first-line antituberculosis drugs.
        Expert Opin Drug Saf. 2006; 5: 231-249
        • Senousy BE
        • Belal SI
        • Draganov PV.
        Hepatotoxic effects of therapies for tuberculosis.
        Nat Rev Gastroenterol Hepatol. 2010; 7: 543-556
        • Salindri AD
        • Wang JY
        • Lin HH
        • et al.
        Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002-2013.
        Int J Infect Dis. 2019; 84: 127-130
        • Chidambaram V
        • Ruelas CJ
        • Kumar A
        • et al.
        The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis.
        Sci Rep. 2021; 11: 15283
        • Thygesen K
        • Alpert JS
        • Jaffe AS
        • et al.
        Fourth Universal Definition of Myocardial Infarction (2018).
        J Am Coll Cardiol. 2018; 72: 2231-2264
        • State Health and Family Planning Commission of the People's Republic of China
        Diagnostic criteria of pulmonary tuberculosis.
        Electronic J Emerging Infect Dis. 2018; 3: 59-61
        • State Health and Family Planning Commission of the People's Republic of China
        Tuberculosis classification.
        Electronic J Emerging Infect Dis. 2018; 3: 191-192
        • Xu X
        • Cai L
        • Chen T
        • et al.
        Predictive value of inflammation-based Glasgow prognostic score, platelet-lymphocyte ratio, and global registry of acute coronary events score for major cardiovascular and cerebrovascular events during hospitalization in patients with acute myocardial infarction.
        Aging (Albany NY). 2021; 13: 18274-18286
        • Koppie TM
        • Serio AM
        • Vickers AJ
        • et al.
        Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer.
        Cancer. 2008; 112: 2384-2392
        • Charlson M
        • Szatrowski TP
        • Peterson J
        • et al.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47: 1245-1251
        • Mehran R
        • Rao SV
        • Bhatt DL
        • et al.
        Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium.
        Circulation. 2011; 123: 2736-2747
        • Wiviott SD
        • Antman EM
        • Gibson CM
        • et al.
        Evaluation of prasugrel compared with clopidogrel in patients with acute coronary syndromes: design and rationale for the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38).
        Am Heart J. 2006; 152: 627-635
        • Schulman S
        • Kearon C.
        Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.
        J Thromb Haemost. 2005; 3: 692-694
        • GUSTO Investigators
        An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
        N Engl J Med. 1993; 329: 673-682
        • Buratto E
        • Shi WY
        • Wynne R
        • et al.
        Improved survival after the Ross procedure compared with mechanical aortic valve replacement.
        J Am Coll Cardiol. 2018; 71: 1337-1344
        • Austin PC.
        Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement.
        J Thorac Cardiovasc Surg. 2007; 134: 1128-1135
        • López-López JP
        • Posada-Martínez EL
        • Saldarriaga C
        • et al.
        Tuberculosis and the heart.
        J Am Heart Assoc. 2021; 10: e19435
        • Monedero-Recuero I
        • Hernando-Marrupe L
        • Sánchez-Montalvá A
        • et al.
        QTc and anti-tuberculosis drugs: a perfect storm or a tempest in a teacup? Review of evidence and a risk assessment.
        Int J Tuberc Lung Dis. 2018; (Oct 26. Online ahead of print. PMID:30366516)
        • Nair M
        • Bhagirath P
        • Gothi R
        • et al.
        Life-threatening ventricular arrhythmia as first presentation of tuberculosis—early diagnosis and successful treatment: a case series.
        Pacing Clin Electrophysiol. 2020; 43: 418-422
        • Jiang Z
        • Wu H
        • Duan Z
        • et al.
        Proton-pump inhibitors can decrease gastrointestinal bleeding after percutaneous coronary intervention.
        Clin Res Hepatol Gastroenterol. 2013; 37: 636-641
        • Tanigawa T
        • Watanabe T
        • Nadatani Y
        • et al.
        Gastrointestinal bleeding after percutaneous coronary intervention.
        Digestion. 2011; 83: 153-160
        • Krag M
        • Marker S
        • Perner A
        • et al.
        Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU.
        N Engl J Med. 2018; 379: 2199-2208
        • Li Y
        • Wu Q
        • Chen Y.
        Myocardial infarction and tuberculosis.
        Acta Cardiol. 2012; 67: 371-372