A study published in the journal Spine has examined the increased risk of acute myocardial infarction in patients with spinal cord injury, and suggested that the findings have broad implications for the surveillance of spinal cord injury patients.
The retrospective cohort study, led by Tse-Yen Yang, China Medical University Hospital, Taichung, Taiwan, was derived from the National Health Insurance Research Database of Taiwan.
The authors point to information taken from the World Health Organization which indicates that cardiovascular diseases are the most frequent causes of death in patients with spinal cord injury compared with those in the general population. The aim of this study was to examine this relationship and to consider its implications.
The spinal cord injury group comprised 22,197 patients. Case and control patients were based on risk-set sampling in a 1:4 ratio, and Yang and colleagues excluded patients with a prior diagnosis of acute myocardial infraction. Comorbidities were categorised as the proportion of prior illnesses in the spinal cord injury and non-injury groups. The Cox proportion model was used to explore the adjusted hazard ratio for developing infarction between the case and control groups.
Patients with spinal cord injury were significantly more likely to exhibit pre-existing illnesses associated with acute myocardial infraction than patients without such injuries. Patients with cord injuries exhibited significantly higher adjusted hazard ratios (aHRs) for developing myocardial infarction than patients without (aHR = 1.17; p<0.05). Spinal cord injury patients were associated with a subsequent myocardial infarction 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 infarction risk. Furthermore, T-spine injury was significantly associated with an infarction risk (aHR = 1.38; p<0.05).
As such, the authors concluded that patients with as diagnosis of spinal cord injury exhibited an increased risk of actue myocardial infarction compared with patients without injury. Yang and colleagues write that “These findings have broad implications for surveillance among patients with spinal cord injury, and future studies should evaluate whether risk factor modification can decrease acute myocardial infarction risk among patients with spinal cord injury.”