Conti Alberto, Alesi Andrea, Trausi Federica, Scorpiniti Margherita, Angeli Elena, Bigiarini Sofia, Bianchi Simone, Donnini Chiara, Lazzeretti Delia, Padeletti Luigi
From the *Atrial Fibrillation Outpatient Clinic and Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy; and †Dysrhytmias Unit, Department of Cardiology; Careggi University Hospital, Florence, Italy.
Crit Pathw Cardiol. 2014 Dec;13(4):141-6. doi: 10.1097/HPC.0000000000000028.
Hypertension and atrial fibrillation (AFib) frequently coexist in clinical practice. However, it is unclear whether this association per se or in combination with coronary artery disease (CAD) is a predictor of adverse outcomes.
The aim of this study is to recognize and treat CAD in patients with hypertension and AFib.
Patients with long-standing hypertension and recent-onset AFib (lasting ≤48 hours) were enrolled and managed with standard care regardless of the presence of troponin elevations (e-TnI) (group 1, n=636, 2010-2011 years) or managed with tailored-care including echocardiography and stress testing when presenting with e-TnI (group 2, n=663, 2012-2013 years).
The composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization, and death at the 6-month follow-up.
Out of 1299 patients enrolled, those with e-TnI (56 and 57 in groups 2 and 1, respectively, P=0.768) were more likely to admit in group 2 vs. group 1 (21 vs. 32, respectively, P=0.060), and less likely to undergo stress testing in group 2 vs. group 1 (15 vs. 1, respectively, P<0.001). Twenty-one patients in group 2 were admitted with positive stress testing (n=9) or high e-TnI (n=12; 1.04±1.98 ng/mL); conversely 35 were discharged with negative stress testing (n=6) or very-low e-TnI (n=29; 0.27±0.22 ng/mL). Finally, 7 patients vs. 1, in groups 2 and 1, respectively, underwent revascularization (P=0.032), and 3 vs. 12 reached the endpoint (P=0.024). On multivariate analysis, e-TnI, known CAD and age were predictors of the endpoint.
In patients with hypertension, AFib, and e-TnI, tailored-care inclusive of echocardiography and stress testing succeeded in recognizing and treating CAD avoiding adverse events without increase in admissions.
在临床实践中，高血压和心房颤动（AFib）常常并存。然而，尚不清楚这种关联本身或与冠状动脉疾病（CAD）合并存在时是否是不良结局的预测因素。
本研究的目的是识别并治疗高血压合并AFib患者的CAD。
纳入患有长期高血压和近期发作的AFib（持续时间≤48小时）的患者，无论肌钙蛋白升高（e-TnI）情况如何，均采用标准治疗（第1组，n = 636，2010 - 2011年）；或在出现e-TnI时采用包括超声心动图和负荷试验在内的个性化治疗（第2组，n = 663，2012 - 2013年）。
6个月随访时包括中风、急性冠状动脉综合征、血运重建和死亡在内的缺血性血管事件的复合终点。
在纳入的1299例患者中，有e-TnI的患者（第2组和第1组分别为56例和57例，P = 0.768）在第2组比第1组更有可能入院（分别为21例和32例，P = 0.060），且在第2组比第1组接受负荷试验的可能性更小（分别为15例和1例，P < 0.001）。第2组中有21例患者因负荷试验阳性（n = 9）或e-TnI升高（n = 12；1.04±1.98 ng/mL）入院；相反，35例患者因负荷试验阴性（n = 6）或e-TnI极低（n = 29；0.27±0.22 ng/mL）出院。最后，第2组和第1组分别有7例和1例患者接受了血运重建（P = 0.032），3例和12例达到终点（P = 0.024）。多因素分析显示，e-TnI、已知CAD和年龄是终点的预测因素。
在患有高血压、AFib和e-TnI的患者中，包括超声心动图和负荷试验在内的个性化治疗成功识别并治疗了CAD，避免了不良事件且未增加入院率。
