Electrophysiology Research Foundation, and RWJ Medical School, Department of Medicine, 161 Washington Valley Road, Warren, NJ 07059, USA.
J Am Coll Cardiol. 2011 Nov 1;58(19):1975-85. doi: 10.1016/j.jacc.2011.07.036.
The impact of individual antiarrhythmic drugs (AADs) on mortality and hospital stay in atrial fibrillation (AF) was evaluated.
Cardiovascular (CV) outcomes in AF patients receiving pharmacologic rhythm control therapy have not been compared with rate control therapy on the basis of AAD selection.
We compared CV outcomes in the AFFIRM (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) trial in subgroups defined by the initial AAD selected with propensity score matched subgroups from the rate arm (Rate).
Seven hundred twenty-nine amiodarone patients, 606 sotalol patients, and 268 Class 1C patients were matched. The composite outcome of mortality or cardiovascular hospital stays (CVH) showed better outcomes with Rate compared with amiodarone (hazard ratio [HR]: 1.18, 95% confidence interval [CI]: 1.03 to 1.36, p = 0.02), sotalol (HR: 1.32, 95% CI: 1.13 to 1.54, p < 0.001), and Class 1C (HR: 1.22, 95% CI: 0.97 to 1.56, p = 0.10). There was a nonsignificant increase in mortality with amiodarone (HR: 1.20, 95% CI: 0.94 to 1.53, p = 0.15) with the risk of non-CV death being significantly higher with amiodarone versus Rate (HR: 1.11, 95% CI: 1.01 to 1.24, p = 0.04). First CVH event rates at 3 years were 47% for amiodarone, 50% for sotalol, and 44% for Class 1C versus 40%, 40%, and 36%, respectively, for Rate (amiodarone HR: 1.20, 95% CI: 1.03 to 1.40, p = 0.02, sotalol HR: 1.364, 95% CI: 1.16 to 1.611, p < 0.001, Class 1C HR: 1.24, 95% CI: 0.96 to 1.60, p = 0.09). Time to CVH with intensive care unit stay or death was shorter with amiodarone (HR: 1.22, 95% CI: 1.02 to 1.46, p = 0.03).
In AFFIRM, composite mortality and CVH outcomes differed for Rate and AADs due to differences in CVH; CVH event rates during follow-up were high for all cohorts, but they were higher for all groups on AADs. Death, intensive care unit hospital stay, and non-CV death were more frequent with amiodarone.
评估个体抗心律失常药物 (AAD) 对心房颤动 (AF) 患者死亡率和住院时间的影响。
接受药物节律控制治疗的 AF 患者的心血管 (CV) 结局尚未根据 AAD 选择与心率控制治疗进行比较。
我们比较了 AFFIRM（房颤节律管理随访研究）试验中根据初始 AAD 选择的 CV 结局亚组，这些亚组是通过倾向评分匹配来自心率组（Rate）的亚组定义的。
匹配了 729 名胺碘酮患者、606 名索他洛尔患者和 268 名 Ic 类患者。死亡率或心血管住院（CVH）的复合结局显示，与胺碘酮（风险比 [HR]：1.18，95%置信区间 [CI]：1.03 至 1.36，p = 0.02）、索他洛尔（HR：1.32，95% CI：1.13 至 1.54，p < 0.001）和 Ic 类（HR：1.22，95% CI：0.97 至 1.56，p = 0.10）相比，Rate 组的结果更好。胺碘酮的死亡率呈升高趋势（HR：1.20，95% CI：0.94 至 1.53，p = 0.15），但与 Rate 相比，非 CV 死亡风险显著更高（HR：1.11，95% CI：1.01 至 1.24，p = 0.04）。3 年时首次 CVH 事件的发生率分别为胺碘酮组 47%、索他洛尔组 50%和 Ic 类组 44%，而 Rate 组为 40%、40%和 36%（胺碘酮 HR：1.20，95% CI：1.03 至 1.40，p = 0.02，索他洛尔 HR：1.364，95% CI：1.16 至 1.611，p < 0.001，Ic 类 HR：1.24，95% CI：0.96 至 1.60，p = 0.09）。胺碘酮组 ICU 住院或死亡的 CVH 时间较短（HR：1.22，95% CI：1.02 至 1.46，p = 0.03）。
在 AFFIRM 中，由于 CVH 不同，Rate 和 AAD 的复合死亡率和 CVH 结局不同；所有队列在随访期间的 CVH 发生率均较高，但所有 AAD 组的发生率更高。胺碘酮组的死亡、ICU 住院和非 CV 死亡更为频繁。
