Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN 55455, USA.
JAMA Intern Med. 2013 Jan 14;173(1):29-35. doi: 10.1001/2013.jamainternmed.744.
It is unknown whether atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. This association was examined in 2 population-based cohorts.
In the Atherosclerosis Risk in Communities (ARIC) Study, we analyzed data from 15 439 participants (baseline age, 45-64 years; 55.2% women; and 26.6% black) from baseline (1987-1989) through December 31, 2001. In the Cardiovascular Health Study (CHS), we analyzed data from 5479 participants (baseline age, ≥65 years; 58.2% women; and 15.4% black) from baseline (first cohort, 1989-1990; second cohort, 1992-1993) through December 31, 2006. The main outcome was physician-adjudicated SCD, defined as death from a sudden, pulseless condition presumed to be due to a ventricular tachyarrhythmia. The secondary outcome was non-SCD (NSCD), defined as coronary heart disease death not meeting SCD criteria. We used Cox proportional hazards models to assess the association between AF and SCD/NSCD, adjusting for baseline demographic and cardiovascular risk factors.
In the ARIC Study, 894 AF, 269 SCD, and 233 NSCD events occurred during follow-up (median, 13.1 years). The crude incidence rates of SCD were 2.89 per 1000 person-years (with AF) and 1.30 per 1000 person-years (without AF). The multivariable hazard ratios (HRs) (95% CIs) of AF for SCD and NSCD were 3.26 (2.17-4.91) and 2.43 (1.60-3.71), respectively. In the CHS, 1458 AF, 292 SCD, and 581 NSCD events occurred during follow-up (median, 13.1 years). The crude incidence rates of SCD were 12.00 per 1000 person-years (with AF) and 3.82 per 1000 person-years (without AF). The multivariable HRs (95% CIs) of AF for SCD and NSCD were 2.14 (1.60-2.87) and 3.10 (2.58-3.72), respectively. The meta-analyzed HRs (95% CIs) of AF for SCD and NSCD were 2.47 (1.95-3.13) and 2.98 (2.52-3.53), respectively.
Incident AF is associated with an increased risk of SCD and NSCD in the general population. Additional research to identify predictors of SCD in patients with AF is warranted.
目前尚不清楚心房颤动（AF）是否会增加一般人群中心脏性猝死（SCD）的风险。本研究在两个基于人群的队列中对此进行了研究。
在动脉粥样硬化风险社区（ARIC）研究中，我们分析了来自基线（1987-1989 年）至 2001 年 12 月 31 日的 15439 名参与者（基线年龄 45-64 岁；55.2%为女性；26.6%为黑人）的数据。在心血管健康研究（CHS）中，我们分析了来自基线（第一队列，1989-1990 年；第二队列，1992-1993 年）至 2006 年 12 月 31 日的 5479 名参与者（基线年龄≥65 岁；58.2%为女性；15.4%为黑人）的数据。主要结局是经医生判定的 SCD，定义为突然发生、无脉搏的状况，推测是由于室性心动过速/颤动引起的死亡。次要结局是非 SCD（NSCD），定义为不符合 SCD 标准的冠心病死亡。我们使用 Cox 比例风险模型评估 AF 与 SCD/NSCD 之间的关联，调整了基线人口统计学和心血管危险因素。
在 ARIC 研究中，894 例 AF、269 例 SCD 和 233 例 NSCD 事件在随访期间发生（中位数为 13.1 年）。SCD 的粗发生率为 2.89/1000 人年（有 AF）和 1.30/1000 人年（无 AF）。AF 发生 SCD 和 NSCD 的多变量风险比（HR）（95%CI）分别为 3.26（2.17-4.91）和 2.43（1.60-3.71）。在 CHS 中，在随访期间（中位数 13.1 年）发生了 1458 例 AF、292 例 SCD 和 581 例 NSCD 事件。SCD 的粗发生率为 12.00/1000 人年（有 AF）和 3.82/1000 人年（无 AF）。AF 发生 SCD 和 NSCD 的多变量 HR（95%CI）分别为 2.14（1.60-2.87）和 3.10（2.58-3.72）。AF 发生 SCD 和 NSCD 的荟萃分析 HR（95%CI）分别为 2.47（1.95-3.13）和 2.98（2.52-3.53）。
新发 AF 与一般人群中心脏性猝死和非 SCD 的风险增加有关。需要进一步研究以确定 AF 患者发生 SCD 的预测因素。
