2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
Cardiol J. 2010;17(1):57-64.
The purpose of this study was to assess the association between new onset of atrial fibrillation (AF) and in-hospital management and mortality in acute coronary syndrome patients admitted to hospitals without on-site invasive facilities.
We assessed data concerning in-hospital management and mortality of 24 patients with, and 977 patients without, new onset of AF from the Krakow Registry of Acute Coronary Syndromes database.
Patients with new onset of AF were older and more likely to have diabetes, chronic obstructive pulmonary disease, cardiogenic shock and chest pain on admission, and a shorter time from the onset of symptoms to admission. These patients more frequently received glycoprotein IIb/IIIa inhibitors, thrombolytics, and were less likely to be treated with statins during their hospital stay. Risk of AF occurrence was lower in patients treated with statins (1.9% vs 5.2%; p = 0.021). Among patients treated conservatively, in-hospital mortality was higher in patients with new onset of AF (8.1% vs 33.3%; p = 0.001). Independent predictors of inhospital death in this group of patients were: new onset of AF, age, cardiogenic shock, chronic obstructive pulmonary disease, history of renal insufficiency, and discharge diagnosis.
New onset of AF is associated with excessive in-hospital mortality in acute coronary syndrome patients staying on conservative treatment in community hospitals without on-site invasive facilities.
本研究旨在评估在无现场介入设施的医院中，新发心房颤动（AF）与急性冠状动脉综合征患者的院内管理和死亡率之间的关系。
我们评估了来自克拉科夫急性冠状动脉综合征数据库的 24 例新发 AF 患者和 977 例无新发 AF 患者的院内管理和死亡率数据。
新发 AF 患者年龄较大，更有可能患有糖尿病、慢性阻塞性肺疾病、心源性休克和入院时胸痛，且从症状发作到入院的时间更短。这些患者更频繁地接受糖蛋白 IIb/IIIa 抑制剂、溶栓药物治疗，住院期间接受他汀类药物治疗的可能性较小。接受他汀类药物治疗的患者发生 AF 的风险较低（1.9% vs 5.2%；p = 0.021）。在接受保守治疗的患者中，新发 AF 患者的院内死亡率更高（8.1% vs 33.3%；p = 0.001）。该组患者院内死亡的独立预测因素包括：新发 AF、年龄、心源性休克、慢性阻塞性肺疾病、肾功能不全史和出院诊断。
新发 AF 与在无现场介入设施的社区医院接受保守治疗的急性冠状动脉综合征患者的院内死亡率过高有关。
