心房颤动和急性心肌梗死：抗血栓治疗与结局。

Atrial fibrillation and acute myocardial infarction: antithrombotic therapy and outcomes.

机构信息

Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.

出版信息

Am J Med. 2012 Sep;125(9):897-905. doi: 10.1016/j.amjmed.2012.04.006. Epub 2012 Jul 13.

DOI:10.1016/j.amjmed.2012.04.006

PMID:22795814

Abstract

BACKGROUND

Atrial fibrillation guidelines recommend long-term use of warfarin according to a patient's predicted risk of stroke. After acute myocardial infarction, however, combining warfarin and antiplatelet medications poses challenges.

METHODS

By using data from more than 69,255 patients with acute myocardial infarction who were enrolled in the National Cardiovascular Data Registry's Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines at 309 hospitals from July 1, 2008, to September 30, 2009, we describe the characteristics and outcomes of the population with myocardial infarction with atrial fibrillation diagnosed within 2 weeks before index myocardial infarction admission (7.1%, N=4947). Use of discharge antithrombotic therapy is described overall and across levels of predicted stroke and bleeding risks.

RESULTS

Compared with patients without atrial fibrillation, those with atrial fibrillation before their index myocardial infarction were older and had more comorbidities and worse in-hospital outcomes. Only 32.5% of patients with atrial fibrillation were taking warfarin before their myocardial infarction admission. In these patients, use of warfarin at discharge increased with higher Congestive heart failure, Hypertension, Age, Diabetes, Stroke [Doubled] (CHADS(2)) risk strata (28.5%, 34.6%, and 43.5% for CHADS(2) scores 0, 1, and ≥2; P<.001) and increased in patients at low, intermediate, and high risk of bleeding (25.4%, 42.3%, and 42.1%; P=.004). Triple therapy at discharge (aspirin plus clopidogrel plus warfarin) was used in a minority of this population (14.6%).

CONCLUSIONS

Use of warfarin at discharge in patients with atrial fibrillation is greater among those with higher stroke and bleeding risks, but despite higher-risk profiles, less than half received warfarin at discharge. These findings highlight that clarification is needed to guide choice of antithrombotic therapy for patients with both atrial fibrillation and acute myocardial infarction.

摘要

背景

房颤指南建议根据患者中风的预测风险，长期使用华法林。然而，在急性心肌梗死后，华法林与抗血小板药物联合使用存在挑战。

方法

利用 2008 年 7 月 1 日至 2009 年 9 月 30 日在全国心血管数据注册中心急性冠状动脉治疗和干预结果网络注册中心-与指南（Get With the Guidelines）的 309 家医院登记的 69255 例急性心肌梗死患者的数据，我们描述了在索引性心肌梗死入院前 2 周内诊断出患有房颤（7.1%，N=4947）的人群的特征和结局。总体描述了出院抗血栓治疗的使用情况，并按中风和出血风险的预测水平进行了分类。

结果

与无房颤的患者相比，那些在索引性心肌梗死前患有房颤的患者年龄较大，合并症更多，住院期间结局更差。仅有 32.5%的房颤患者在入院前正在服用华法林。在这些患者中，华法林的使用率随着充血性心力衰竭、高血压、年龄、糖尿病、中风[加倍]（CHADS2）风险分层（CHADS2 评分为 0、1 和≥2 的患者分别为 28.5%、34.6%和 43.5%；P<.001）而增加，并且在出血风险低、中、高的患者中也增加（25.4%、42.3%和 42.1%；P=.004）。出院时采用三联疗法（阿司匹林加氯吡格雷加华法林）的患者为数较少（14.6%）。