Risk of cardiovascular events and pulmonary hypertension following splenectomy - a Danish population-based cohort study from 1996-2012

Abstract

Splenectomized patients are at increased risk of cardiovascular events, but it remains unclear whether this is due to lack of the spleen or due to the underlying disease leading to splenectomy. We aimed to assess the risk of myocardial infarction, pulmonary hypertension, and stroke following splenectomy. We identified patients splenectomized in Denmark between 1996 and 2012. We constructed two comparison cohorts: an age- and sex-matched general population cohort and a disease-matched cohort based on the splenectomy-related underlying disease. We computed 5-year cumulative incidences and adjusted hazard ratios of myocardial infarction, pulmonary hypertension, and stroke for the three cohorts. The study included 5,306 splenectomized patients, 53,060 members of the general population, and 11,651 disease-matched patients. During the 5-year follow-up, 1.3% of splenectomized patients had a myocardial infarction versus 1.8% of the population cohort. The adjusted hazard ratio for myocardial infarction in splenectomized patients versus the population cohort was 1.24 (95% confidence interval: 1.01-1.52). The 5-year cumulative incidence of pulmonary hypertension was 0.4% among splenectomized subjects and 0.2% in the population cohort [adjusted hazard ratio 3.25 (95% confidence interval: 1.93-5.45)], while that of stroke was 3.3% among splenectomized patients versus 2.6% in the population cohort [adjusted hazard ratio 2.04 (95% confidence interval: 1.78-2.35)]. When comparing splenectomized subjects with the disease-matched cohort, only stroke risk was elevated, with 5-year risks of 3.0% and 2.3%, respectively [adjusted hazard ratio 1.56 (95% confidence interval: 1.26-1.92)]. In conclusion, splenectomized patients were at increased risk of stroke. Additionally, we found that underlying splenectomy-related diseases explained the increased risk of myocardial infarction and pulmonary hypertension following splenectomy.

Figure 1.

Cumulative risk of myocardial infarction following splenectomy (in years). (A) Cumulative risk of myocardial infarction (MI) in splenectomized patients compared with the risk in the general population cohort. (B) Cumulative risk of MI in splenectomized patients compared with the risk in the disease-matched cohort.

Figure 2.

Cumulative risk of pulmonary hypertension following splenectomy (in years). (A) Cumulative risk of pulmonary hypertension (PH) in splenectomized patients compared with the risk in the general population cohort. (B) Cumulative risk of PH in splenectomized patients compared with the risk in the disease-matched cohort.

Figure 3.

Cumulative risk of stroke following splenectomy (in years). (A) Cumulative risk of stroke in splenectomized patients compared with the risk in the general population cohort. (B) Cumulative risk of stroke in splenectomized patients compared with the risk in the disease-matched cohort.