Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA.
Cardiol J. 2013;20(4):439-46. doi: 10.5603/CJ.2013.0104.
Atrial fibrillation (AF) and chronic kidney disease (CKD) have both been shown to portend worse outcomes after acute myocardial infarction (MI); however, the benefit of a rhythm control strategy in patients with CKD post-MI is unclear.
We prospectively studied 985 patients with new-onset AF post-MI in the GUSTO-III trial, of whom 413 (42%) had CKD (creatinine clearance < 60 mL/min). A rhythm control strategy, defined as the use of an antiarrhythmic medication and/or electrical cardioversion, was used in 346 (35%) of patients.
A rhythm control strategy was used in 34% of patients with CKD and 36% of patients with no CKD. At hospital discharge, sinus rhythm was present in 487 (76%) of patients treated with a rate control strategy, vs. 276 (80%) in those treated with rhythm control (p = 0.20). CKD was associated with a lower odds of sinus rhythm at discharge (unadjusted OR 0.56, 95% CI 0.38-0.84, p < 0.001). However, in multivariable analyses, treatment with a rhythm control strategy was not associated with discharge rhythm (HR 1.068, 95% CI 0.69-1.66, p = 0.77), 30-day mortality (HR 0.78, 95% CI 0.54-1.12, p = 0.18) or mortality from day 30 to 1 year (HR 1.00, 95% CI 0.59-1.69, p = 0.99). CKD status did not significantly impact the relationship between rhythm control and outcomes.
Treatment with a rhythm or rate control strategy does not signifi cantly impact short-term or long-term mortality in patients with post-MI AF, regardless of kidney disease status. Future studies to investigate the optimal management of AF in CKD patients are needed.
心房颤动（AF）和慢性肾脏病（CKD）均已显示在急性心肌梗死（MI）后预后更差；然而，MI 后 CKD 患者节律控制策略的获益尚不清楚。
我们前瞻性研究了 GUSTO-III 试验中新发 MI 后新发 AF 的 985 例患者，其中 413 例（42%）患有 CKD（肌酐清除率 < 60 mL/min）。节律控制策略定义为使用抗心律失常药物和/或电复律，在 346 例（35%）患者中使用。
34%的 CKD 患者和 36%的无 CKD 患者采用节律控制策略。在出院时，接受心率控制策略治疗的患者中 487 例（76%）存在窦性节律，而接受节律控制策略治疗的患者中 276 例（80%）存在窦性节律（p = 0.20）。CKD 与出院时窦性节律的可能性较低相关（未调整的 OR 0.56，95%CI 0.38-0.84，p < 0.001）。然而，在多变量分析中，节律控制策略的治疗与出院节律（HR 1.068，95%CI 0.69-1.66，p = 0.77）、30 天死亡率（HR 0.78，95%CI 0.54-1.12，p = 0.18）或 30 天至 1 年死亡率（HR 1.00，95%CI 0.59-1.69，p = 0.99）无关。CKD 状态并未显著影响节律控制与结局之间的关系。
MI 后 AF 患者采用节律或心率控制策略治疗并不会显著影响短期或长期死亡率，无论肾脏病状况如何。需要进一步的研究来探讨 CKD 患者 AF 的最佳管理方法。
