Pastori Daniele, Pignatelli Pasquale, Saliola Mirella, Carnevale Roberto, Vicario Tommasa, Del Ben Maria, Cangemi Roberto, Barillà Francesco, Lip Gregory Y H, Violi Francesco
I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
Int J Cardiol. 2015 Dec 15;201:513-6. doi: 10.1016/j.ijcard.2015.08.054. Epub 2015 Aug 5.
Time in therapeutic range (TTR) reflects the quality of anticoagulation and is inversely correlated with ischemic stroke in atrial fibrillation (AF) patients. Few data on the relationship between TTR and myocardial infarction (MI) are available. We investigated the association between TTR and Major Adverse Cardiovascular Events (MACE) in a cohort of anticoagulated AF patients.
We calculated TTR for 627 AF patients on vitamin K antagonists, who were followed for a median of 30.8 months (1755 patients/year). The primary outcome was a combined endpoint of MACE including fatal/nonfatal MI and cardiovascular death.
Mean age was 73.3 (±8.2) years, and 40.2% were women. During follow-up, we recorded 67 events: 19 stroke/TIA (1.1%/year) and 48 MACE (2.9%/year): 24 MI and 24 cardiovascular deaths. The cohort was categorized according to tertiles of TTR values: TTR 13-58%, 59-74%, and 75-100%. There was a significant increased rate of MACE across tertiles of TTR (Log-Rank test: p<0.001). On Cox proportion hazard analysis, the 2nd vs. 1st tertile of TTR (p=0.002, hazard ratio [HR] 0.347, confidence interval [CI] 95% 0.177-0.680), 3rd vs. 1st tertile of TTR (p<0.001, HR 0.164, CI 95% 0.067-0.402), age (p<0.001, HR 1.094, CI 95% 1.042-1.148), history of stroke/TIA (p=0.015, HR 2.294, CI 95% 1.172-4.490) and smoking (p=0.003, HR 3.450, CI 95% 1.532-7.769) predicted MACE.
TTR was an independent predictor of MACE in our cohort of AF patients. Our findings suggest that a good anticoagulation control is necessary to reduce not only the risk of stroke but also that of MACE.
治疗范围内时间（TTR）反映了抗凝治疗的质量，并且与心房颤动（AF）患者的缺血性卒中呈负相关。关于TTR与心肌梗死（MI）之间关系的数据很少。我们在一组接受抗凝治疗的AF患者中研究了TTR与主要不良心血管事件（MACE）之间的关联。
我们计算了627例服用维生素K拮抗剂的AF患者的TTR，这些患者的中位随访时间为30.8个月（1755患者/年）。主要结局是MACE的复合终点，包括致命性/非致命性MI和心血管死亡。
平均年龄为73.3（±8.2）岁，女性占40.2%。在随访期间，我们记录了67起事件：19例卒中/短暂性脑缺血发作（TIA）（1.1%/年）和48例MACE（2.9%/年）：24例MI和24例心血管死亡。根据TTR值的三分位数对队列进行分类：TTR为13 - 58%、59 - 74%和75 - 100%。TTR三分位数之间的MACE发生率显著增加（对数秩检验：p<0.001）。在Cox比例风险分析中，TTR的第二三分位数与第一三分位数相比（p = 0.002，风险比[HR] 0.347，95%置信区间[CI] 0.177 - 0.680），TTR的第三三分位数与第一三分位数相比（p<0.001，HR 0.164，CI 95% 0.067 - 0.402）、年龄（p<0.001，HR 1.094，CI 95% 1.042 - 1.148）、卒中/TIA病史（p = 0.015，HR 2.294，CI 95% 1.172 - 4.490）和吸烟（p = 0.003，HR 3.450，CI 95% 1.532 - 7.769）可预测MACE。
在我们的AF患者队列中，TTR是MACE的独立预测因素。我们的研究结果表明，良好的抗凝控制不仅对于降低卒中风险是必要的，而且对于降低MACE风险也是必要的。
