Siu Chung-Wah, Jim Man-Hong, Ho Hee-Hwa, Miu Raymond, Lee Stephen W L, Lau Chu-Pak, Tse Hung-Fat
Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China.
Chest. 2007 Jul;132(1):44-9. doi: 10.1378/chest.06-2733. Epub 2007 Mar 30.
Atrial fibrillation (AF) that occurs as a frequent complication of myocardial infarction (MI) is associated with a poor clinical outcome. It nonetheless remains uncertain whether AF that occurs transiently during MI is associated with a subsequent increased risk of the development of AF and ischemic stroke.
We retrospectively studied the impact of transient AF on the long-term risk of the occurrence of AF, ischemic stroke, and mortality in 431 consecutive patients (mean [+/- SEM] age, 64 +/- 1 years; 75% men). All patients had experienced an acute inferior ST-segment-elevation MI and had preserved left ventricular ejection fraction (LVEF) [> 45%].
All patients were in sinus rhythm on hospital admission, and transient AF was observed in 59 patients (13.7%) during their hospitalization for MI. On hospital discharge, all patients were in sinus rhythm and had been prescribed antiplatelet agents alone as antithrombotic therapy. Patients in whom transient AF developed during MI were older (mean age, 70 +/- 1.4 vs 64 +/- 0.7 years, respectively; p < 0.01) and more likely to be women (37% vs 23%, respectively; p < 0.02) compared with those without AF. At 1-year follow-up, the incidence of AF (22.0% vs 1.3%, respectively; p < 0.01) and ischemic stroke (10.2% vs 1.8%, respectively; p < 0.01) was higher in patients with transient AF than in those without transient AF. The total mortality rate was nonetheless similar (5.6% vs 6.8%, respectively; p = 0.73); Cox regression analysis demonstrated that age > 65 years and transient AF during MI were independent predictors of the subsequent occurrence of AF and the development of ischemic stroke.
Transient AF complicating acute inferior MI is associated with an increased future risk of AF occurrence and ischemic stroke in patients with preserved LVEF, despite the use of antiplatelet therapy.
心房颤动（AF）作为心肌梗死（MI）的常见并发症，与不良临床结局相关。然而，MI期间短暂发生的AF是否与随后AF发生风险及缺血性卒中风险增加相关仍不确定。
我们回顾性研究了431例连续患者（平均[±标准误]年龄，64±1岁；75%为男性）中短暂性AF对AF发生、缺血性卒中和死亡长期风险的影响。所有患者均经历急性下壁ST段抬高型MI且左心室射血分数（LVEF）保留[>45%]。
所有患者入院时均为窦性心律，59例患者（13.7%）在MI住院期间出现短暂性AF。出院时，所有患者均为窦性心律，且仅接受抗血小板药物作为抗栓治疗。与未发生AF的患者相比，MI期间发生短暂性AF的患者年龄更大（平均年龄分别为70±1.4岁和64±0.7岁；p<0.01），且女性比例更高（分别为37%和23%；p<0.02）。在1年随访时，短暂性AF患者的AF发生率（分别为22.0%和1.3%；p<0.01）和缺血性卒中发生率（分别为10.2%和1.8%；p<0.01）高于无短暂性AF的患者。然而，总死亡率相似（分别为5.6%和6.8%；p=0.73）；Cox回归分析表明，年龄>65岁和MI期间短暂性AF是随后AF发生和缺血性卒中发生的独立预测因素。
尽管使用了抗血小板治疗，但急性下壁MI并发的短暂性AF与LVEF保留患者未来AF发生风险和缺血性卒中风险增加相关。
