Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Mayo Clin Proc. 2015 Apr;90(4):441-9. doi: 10.1016/j.mayocp.2014.12.025. Epub 2015 Mar 6.
To evaluate the role of systemic anticoagulation using warfarin in patients with post-myocardial infarction left ventricular (LV) aneurysm formation with or without definite LV thrombus formation.
This study included 648 patients with post-myocardial infarction LV aneurysm formation diagnosed retrospectively by 2-dimensional echocardiography from December 1, 1994, to February 29, 2012. Of these 648 patients, 106 patients received warfarin and 542 patients did not. We studied a composite of death, nonfatal myocardial infarction, cerebrovascular accident, and systemic embolization as the primary outcome and a composite of cerebrovascular accident and systemic embolization as the secondary outcome by using propensity score-adjusted multiple Cox proportional hazards regression analysis.
In patients with LV aneurysm, LV thrombus was observed in 89 patients (13.7%) and it was associated with a higher incidence of adverse secondary events (hazard ratio [HR], 3.63; 95% CI, 1.12-11.8; P=.03) in unadjusted analysis. However, in adjusted analysis, anticoagulation did not predict either a better or a worse outcome for primary outcomes (HR, 1.05; 95% CI, 0.67-1.64; P=.84) or for secondary outcomes (HR, 1.52; 95% CI, 0.670-3.46; P=.31). The benefit of anticoagulation was also not established in patients with LV thrombus (HR, 1.38; 95% CI, 0.32-5.97; P=.66).
In patients with ischemic LV aneurysms, oral anticoagulation therapy with warfarin may not be effective enough to reduce cardiac and cerebrovascular events including systemic embolism. Further studies are needed to confirm this finding.
评估使用华法林进行全身抗凝在心肌梗死后伴或不伴明确左心室（LV）血栓形成的 LV 瘤形成患者中的作用。
本研究纳入了 648 例通过二维超声心动图于 1994 年 12 月 1 日至 2012 年 2 月 29 日回顾性诊断的心肌梗死后 LV 瘤形成患者。其中 106 例患者接受了华法林治疗，542 例患者未接受华法林治疗。我们通过倾向评分调整后的多 Cox 比例风险回归分析，研究了死亡、非致死性心肌梗死、卒中和系统性栓塞的复合终点作为主要结局以及卒中和系统性栓塞的复合终点作为次要结局。
在 LV 瘤患者中，89 例（13.7%）存在 LV 血栓，未校正分析中其不良次要事件发生率更高（风险比[HR]，3.63；95%置信区间[CI]，1.12-11.8；P=0.03）。然而，在调整分析中，抗凝治疗并不能预测主要结局（HR，1.05；95%CI，0.67-1.64；P=0.84）或次要结局（HR，1.52；95%CI，0.670-3.46；P=0.31）的预后更好或更差。LV 血栓患者也不能确定抗凝治疗的获益（HR，1.38；95%CI，0.32-5.97；P=0.66）。
在缺血性 LV 瘤患者中，口服华法林抗凝治疗可能不足以减少包括系统性栓塞在内的心脏和脑血管事件。需要进一步的研究来证实这一发现。
