Giglioli Cristina, Minelli Martina, Chiostri Marco, Landi Daniele, Romano Salvatore Mario, Balzi Daniela, Valente Serafina, Padeletti Luigi, Gensini Gian Franco, Cecchi Emanuele
Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, 50134, Florence, Italy,
Intern Emerg Med. 2014 Aug;9(5):521-8. doi: 10.1007/s11739-013-0959-1. Epub 2013 Jun 1.
Several studies have evaluated the prognostic impact of atrial fibrillation (AF) in ST-elevation myocardial infarction (STEMI) patients, but scarce data are available on the role of AF in non-ST-elevation acute coronary syndromes (NSTE-ACS). The aim of this study was to investigate long-term outcome of NSTE-ACS patients experiencing an episode of AF during in-hospital course. Of 1,147 NSTE-ACS patients, 54.4% for non-STEMI (NSTEMI) and 45.6% for unstable angina, 65 (5.7%) had an episode of AF. Long-term survival was compared with that of 1,082 NSTE-ACS patients who did not develop AF. Patients who developed AF, with respect to those who did not, were older and more frequently with NSTEMI at admission (69.2 vs. 53.5%, p = 0.013), diabetes, dyslipidemia and history of heart failure. Moreover, patients who developed AF had a significantly higher New York Heart Association class and lower values of glomerular filtration rate. During a median follow-up of 40.7 months, we observed a significantly higher mortality in NSTE-ACS patients who developed AF versus those who did not (42.2 vs. 19.8%, p < 0.001). AF occurrence in NSTE-ACS was a significant predictor of mortality at Cox regression (adjusted HR: 1.85; p = 0.03). After propensity score analysis, only patients with AF duration >6 h showed a significantly higher mortality at Cox regression (p = 0.021). Our results suggest that NSTE-ACS patients who develop AF are characterized by a higher clinical complexity. The occurrence of AF, when longer than 6 h, represents an important negative prognostic factor for long-term survival.
多项研究评估了心房颤动（AF）对ST段抬高型心肌梗死（STEMI）患者的预后影响，但关于AF在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）中的作用的数据却很少。本研究的目的是调查NSTE-ACS患者在住院期间发生AF事件的长期预后。在1147例NSTE-ACS患者中，非ST段抬高型心肌梗死（NSTEMI）占54.4%，不稳定型心绞痛占45.6%，其中65例（5.7%）发生了AF事件。将这些患者的长期生存率与1082例未发生AF的NSTE-ACS患者进行了比较。发生AF的患者与未发生AF的患者相比，年龄更大，入院时NSTEMI的发生率更高（69.2%对53.5%，p = 0.013），糖尿病、血脂异常和心力衰竭病史的发生率也更高。此外，发生AF的患者纽约心脏协会心功能分级显著更高，肾小球滤过率更低。在中位随访40.7个月期间，我们观察到发生AF的NSTE-ACS患者的死亡率显著高于未发生AF的患者（42.2%对19.8%，p < 0.001）。在Cox回归分析中，NSTE-ACS患者发生AF是死亡率的显著预测因素（校正风险比：1.85；p = 0.03）。经过倾向评分分析，只有AF持续时间>6小时的患者在Cox回归分析中显示出显著更高的死亡率（p = 0.021）。我们的结果表明，发生AF的NSTE-ACS患者具有更高的临床复杂性。AF持续时间超过6小时是长期生存的重要不良预后因素。
