心房颤动在急性冠状动脉综合征中的影响。

Impact of atrial fibrillation in acute coronary syndromes.

作者信息

Torres Márcia, Rocha Sérgia, Marques Jorge, Nabais Sérgio, Rebelo Adília, Pereira Miguel Alvares, Azevedo Pedro, Correia Adelino

机构信息

Serviço de Cardiologia, Hospital de São Marcos, Braga, Portugal.

出版信息

Rev Port Cardiol. 2008 Nov;27(11):1407-18.

PMID:19227808

Abstract

INTRODUCTION

Atrial fibrillation (AF) is a relatively common arrhythmia in the context of acute coronary syndromes (ACS). However, the impact of AF on these patients' survival is not well established. The present study aimed to estimate the prevalence of AF in ACS patients and to evaluate its impact on in-hospital and six-month post-event mortality, from any cause.

METHODS

This was a retrospective cohort study that included 1183 patients admitted consecutively to a Coronary Care Unit with ACS. Demographic and clinical data and information from various complementary exams were collected and occurrence of AF during the first 48 hours of hospitalization was analyzed. Six-month follow-up was achieved in 95.9% of the patients. Logistic regression statistical analysis was used to identify independent predictors of in-hospital and six-month post-event mortality.

RESULTS

AF was diagnosed in 140 patients (11.8%); these patients were older (73.89 +/- 8.69 vs. 63.20 +/- 12.73 years; p<0.0001) and less likely to be male (60.0% vs. 74.1%; p=0.001), and had a lower prevalence of dyslipidemia (32.9% vs. 44.1%; p=0.001) and smoking (10.0% vs. 25.9%; p<0.0001). Fewer patients with AF underwent reperfusion therapy (19.3% vs. 29.7%; p=0.006), beta-blocker therapy (72.1% vs. 85.7%; p<0.0001), and cardiac catheterization (48.2% vs. 62.9%; p=0.001) or percutaneous coronary intervention (14.3% vs. 23.4%; p=0.01). These patients more frequently developed heart failure (54.3% vs. 28.5%; p<0.0001) and more often presented left ventricular dysfunction (69.3% vs. 57.2%; p=0.002). In patients presenting AF, there were significant increases in in-hospital (12.1% vs. 4.2%; p<0.0001) and six-month mortality (27.2% vs. 8.2%. p<0.0001). In multivariate analysis, AF remained an independent marker of in-hospital (OR 1.95; 95% CI 1.03-3.69; p=0.03) and six-month mortality (OR 2.89; 95% CI 1.67-5.00; p=0.0001), as was age >75 years, severe left ventricular dysfunction and heart failure. The performance of coronary angiography correlated with improved prognosis.

CONCLUSIONS

AF in the context of ACS is an independent predictor of increased in-hospital and six-month mortality. These findings should be taken into consideration in the management and treatment of such patients.

摘要

引言

在急性冠状动脉综合征（ACS）背景下，心房颤动（AF）是一种相对常见的心律失常。然而，AF对这些患者生存的影响尚未完全明确。本研究旨在评估ACS患者中AF的患病率，并评估其对全因住院及事件发生后6个月死亡率的影响。

方法

这是一项回顾性队列研究，纳入了1183例连续入住冠心病监护病房的ACS患者。收集了人口统计学和临床数据以及各种辅助检查的信息，并分析了住院最初48小时内AF的发生情况。95.9%的患者进行了6个月的随访。采用逻辑回归统计分析来确定住院及事件发生后6个月死亡率的独立预测因素。

结果

140例患者（11.8%）被诊断为AF；这些患者年龄较大（73.89±8.69岁 vs. 63.20±12.73岁；p<0.0001），男性比例较低（60.0% vs. 74.1%；p=0.001），血脂异常患病率较低（32.9% vs. 44.1%；p=0.001），吸烟率较低（10.0% vs. 25.9%；p<0.0001）。AF患者接受再灌注治疗（19.3% vs. 29.7%；p=0.006）、β受体阻滞剂治疗（72.1% vs. 85.7%；p<0.0001）、心脏导管检查（48.2% vs. 62.9%；p=0.001）或经皮冠状动脉介入治疗（14.3% vs. 23.4%；p=0.01）的比例较低。这些患者更常发生心力衰竭（54.3% vs. 28.5%；p<0.0001），左心室功能障碍也更常见（69.3% vs. 57.2%；p=0.002）。发生AF的患者住院死亡率（12.1% vs. 4.2%；p<0.0001）和6个月死亡率（27.2% vs. 8.2%，p<0.0001）显著升高。在多变量分析中，AF仍然是住院死亡率（OR 1.95；95%CI 1.03 - 3.69；p=0.03）和6个月死亡率（OR 2.89；95%CI 1.67 - 5.00；p=0.0001）的独立标志物，年龄>75岁、严重左心室功能障碍和心力衰竭也是如此。冠状动脉造影的实施与预后改善相关。