冠状动脉钙化进展与心房颤动：动脉粥样硬化多民族研究
Coronary Artery Calcium Progression and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis.
作者信息
O'Neal Wesley T, Efird Jimmy T, Qureshi Waqas T, Yeboah Joseph, Alonso Alvaro, Heckbert Susan R, Nazarian Saman, Soliman Elsayed Z
机构信息
From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
出版信息
Circ Cardiovasc Imaging. 2015 Dec;8(12). doi: 10.1161/CIRCIMAGING.115.003786.
BACKGROUND
Coronary artery calcium (CAC) measured at a single time point has been associated with an increased risk for atrial fibrillation (AF). It is unknown whether CAC progression over time carries a similar risk.
METHODS AND RESULTS
This analysis included 5612 participants (mean age: 62±10; 52% women; 39% whites; 27% blacks; 20% Hispanics; 12% Chinese Americans) from the Multi-Ethnic Study of Atherosclerosis. Phantom-adjusted Agatston scores for baseline and follow-up measurements were used to compute change in CAC per year (≤0, 1-100, 101-300, and >300 U/year). AF was ascertained by review of hospital discharge records and from Medicare claims data through December 31, 2010. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between CAC progression and AF. Over a median follow-up of 5.6 years (25th, 75th percentiles=5.1, 6.8), a total of 203 (3.6%) incident AF cases were detected. Any CAC progression (>0/year) was associated with an increased risk for AF (HR=1.55, 95% CI=1.10, 2.19), and the risk increased with higher levels of CAC progression (≤0/year: HR=1.0 [reference]; 1-100/year: HR=1.47, 95% CI=1.03, 2.09; 101-300/year: HR=1.92, 95%CI=1.15, 3.20; >300/year: HR=3.23, 95%CI=1.48, 7.05). An interaction was observed by age with the association of CAC progression with AF being stronger for younger (<61 years: HR=3.53, 95% CI=1.29, 9.69) compared with older (≥61 years: HR=1.42, 95% CI=0.99, 2.04) participants (P interaction=0.037).
CONCLUSIONS
CAC progression during an average of 5 to 6 years of follow-up is associated with an increased risk for AF.
背景
单次测量的冠状动脉钙化（CAC）与心房颤动（AF）风险增加相关。目前尚不清楚随时间推移的CAC进展是否具有类似风险。
方法和结果
本分析纳入了动脉粥样硬化多族裔研究中的5612名参与者（平均年龄：62±10岁；52%为女性；39%为白人；27%为黑人；20%为西班牙裔；12%为华裔美国人）。使用基线和随访测量的经体模校正的阿加斯顿评分来计算每年的CAC变化（≤0、1 - 100、101 - 300和>300 U/年）。通过查阅医院出院记录和截至2010年12月31日的医疗保险理赔数据来确定AF。使用Cox回归计算CAC进展与AF之间关联的风险比（HR）和95%置信区间（CI）。在中位随访5.6年（第25、75百分位数 = 5.1、6.8）期间，共检测到203例（3.6%）新发AF病例。任何CAC进展（>0/年）都与AF风险增加相关（HR = 1.55，95% CI = 1.10，2.19），并且随着CAC进展水平的升高风险增加（≤0/年：HR = 1.0[参考值]；1 - 100/年：HR = 1.47，95% CI = 1.03，2.09；101 - 300/年：HR = 1.92，95% CI = 1.15，3.20；>300/年：HR = 3.23，95% CI = 1.48，7.05）。观察到年龄存在交互作用，与年龄较大（≥61岁：HR = 1.42，95% CI = 0.99，2.04）的参与者相比，年龄较小（<61岁：HR = 3.53，95% CI = 1.29，9.69）的参与者中CAC进展与AF的关联更强（P交互作用 = 0.037）。
结论
在平均5至6年的随访期间，CAC进展与AF风险增加相关。
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