Wändell Per, Carlsson Axel C, Holzmann Martin J, Ärnlöv Johan, Johansson Sven-Erik, Sundquist Jan, Sundquist Kristina
Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; Academic Primary Healthcare Centre, Stockholm County Council, Huddinge, Sweden.
Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
Int J Cardiol. 2016 Oct 15;221:789-93. doi: 10.1016/j.ijcard.2016.07.119. Epub 2016 Jul 9.
To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin).
The study population included subjects (n=12,283) 45years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity.
Persistent treatment ("per protocol" treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16-0.41) and for men 0.28 (95% CI 0.20-0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37-0.87), and for men 0.44 95% CI (0.31-0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27-0.80), and for men 0.58 (95% CI 0.38-0.89).
Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients.
研究在初级卫生保健机构中接受华法林或乙酰水杨酸（ASA，阿司匹林）治疗的房颤（AF）患者发生心肌梗死（MI）的风险。
研究人群包括2001年至2007年期间在瑞典75个初级保健中心接受治疗的45岁及以上被诊断为房颤的受试者（n = 12,283）。MI定义为2001年至2010年期间在瑞典患者登记册中登记的因MI住院。使用Cox回归分析，通过估计风险比（HRs）和95%置信区间（95% CIs），探讨华法林或ASA治疗与新发MI之间的关联。对年龄、社会经济因素和心血管合并症进行了调整。
仅接受华法林持续治疗（“按方案”治疗）的女性占32.4%，男性占37.4%；仅接受ASA持续治疗的女性占30.0%，男性占28.1%。与未接受抗血栓治疗的患者相比，接受华法林治疗的女性发生MI的完全调整后HR为0.26（95% CI 0.16 - 0.41），男性为0.28（95% CI 0.20 - 0.39）；接受ASA治疗的女性相应HR为0.57（95% CI 0.37 - 0.87），男性为0.44（95% CI 0.31 - 0.63）。将接受华法林治疗的患者与接受ASA治疗的患者进行比较时，发生MI的完全调整后HR女性为0.46（95% CI 0.27 - 0.80），男性为
