Chun-An Cheng1,2, Chun-Gu Cheng3,4, Hsin Chu1,5,6, Hung-Che Lin7, Chi-Hsiang Chung8,9, Hung-Wen Chiu10, Wu-Chien Chien11,12. 1. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 2. Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wu-Hsing Street, 110, Taipei, Taiwan. 3. Department of Emergency, Armed Taoyuan General Hospital, Taoyuan, Taiwan. 4. Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 5. Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan. 6. Aviation Physiology Research Laboratory, Gangshan Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. 7. Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 8. Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC. 9. School of Public Health, National Defense Medical Center, Taipei, Taiwan. 10. Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wu-Hsing Street, 110, Taipei, Taiwan. hwchiu@tmu.edu.tw. 11. Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC. chienwu@ndmctsgh.edu.tw. 12. School of Public Health, National Defense Medical Center, Taipei, Taiwan. chienwu@ndmctsgh.edu.tw.
Abstract
PURPOSE: Palmar hyperhidrosis (PH) is excessive sweating of the palms resulting from sympathetic overactivity, and patients who undergo endoscopic thoracic sympathectomy (ETS) show reduced cardiac demand after 1 year and improved cerebral perfusion within 2-4 weeks. However, the long-term risks of major adverse cardiovascular events (MACE) following ETS remain unclear. METHODS: We searched the Longitudinal National Health Insurance Database in Taiwan and identified PH patients (International Classification of Disease, Ninth Revision, Clinical Modification diagnostic code 708.8) from the outpatient database and patients who underwent ETS (procedure code 05.29) from the inpatient database between 2000 and 2010; furthermore, we excluded patients younger than 18 years of age or older than 65 years of age. We defined MACE as stroke (diagnostic codes 430-437), myocardial infarction (diagnostic code 410), or death. Patients followed until the first cardiac event or December 31, 2010. Risk factors were identified using a multivariable Cox proportional hazards regression. RESULTS: The incidence of MACE was significantly lower in patients with ETS (0.76%) than without (1.67%). In PH patients, ETS significantly reduced the risk of MACE (adjusted hazard ratio 0.473; 95% confidence interval 0.277-0.808). CONCLUSION: PH patients who underwent ETS showed a reduced risk of MACE over a long-term follow-up period. This result could provide support for patients with PH who are considering undergoing ETS because of its additional cardiovascular benefits.
PURPOSE:Palmar hyperhidrosis (PH) is excessive sweating of the palms resulting from sympathetic overactivity, and patients who undergo endoscopic thoracic sympathectomy (ETS) show reduced cardiac demand after 1 year and improved cerebral perfusion within 2-4 weeks. However, the long-term risks of major adverse cardiovascular events (MACE) following ETS remain unclear. METHODS: We searched the Longitudinal National Health Insurance Database in Taiwan and identified PH patients (International Classification of Disease, Ninth Revision, Clinical Modification diagnostic code 708.8) from the outpatient database and patients who underwent ETS (procedure code 05.29) from the inpatient database between 2000 and 2010; furthermore, we excluded patients younger than 18 years of age or older than 65 years of age. We defined MACE as stroke (diagnostic codes 430-437), myocardial infarction (diagnostic code 410), or death. Patients followed until the first cardiac event or December 31, 2010. Risk factors were identified using a multivariable Cox proportional hazards regression. RESULTS: The incidence of MACE was significantly lower in patients with ETS (0.76%) than without (1.67%). In PH patients, ETS significantly reduced the risk of MACE (adjusted hazard ratio 0.473; 95% confidence interval 0.277-0.808). CONCLUSION: PH patients who underwent ETS showed a reduced risk of MACE over a long-term follow-up period. This result could provide support for patients with PH who are considering undergoing ETS because of its additional cardiovascular benefits.
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