FIACA研究中的死亡率与心房颤动：基于入院诊断的差异效应证据
Mortality and Atrial Fibrillation in the FIACA Study: Evidence of a Differential Effect According to Admission Diagnosis.
作者信息
Clavel-Ruipérez Francisco Guillermo, Consuegra-Sánchez Luciano, Félix Redondo Francisco Javier, Lozano Mera Luis, Mellado-Delgado Pedro, Martínez-Díaz Juan José, López Mínguez José Ramón, Fernández-Bergés Daniel
机构信息
Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain.
Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain.
出版信息
Rev Esp Cardiol (Engl Ed). 2018 Mar;71(3):155-161. doi: 10.1016/j.rec.2017.03.026. Epub 2017 May 18.
INTRODUCTION AND OBJECTIVES
Atrial fibrillation (AF) is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure (DHF) are contradictory. Our objective was to investigate the impact of AF on mortality in patients admitted to hospital for DHF compared with those admitted for other reasons.
METHODS
This retrospective cohort study included all patients admitted to hospital within a 10-year period due to DHF, acute myocardial infarction (AMI), or ischemic stroke (IS), with a median follow-up of 6.2 years.
RESULTS
We included 6613 patients (74 ± 11 years; 54.6% male); 2177 with AMI, 2208 with DHF, and 2228 with IS. Crude postdischarge mortality was higher in patients with AF hospitalized for AMI (incident rate ratio, 2.48; P < .001) and IS (incident rate ratio, 1.84; P < .001) than in those without AF. No differences were found in patients with DHF (incident rate ratio, 0.90; P = .12). In adjusted models, AF was not an independent predictor of in-hospital mortality by clinical diagnosis. However, AF emerged as an independent predictor of postdischarge mortality in patients with AMI (HR, 1.494; P = .001) and IS (HR, 1.426; P < .001), but not in patients admitted for DHF (HR, 0.964; P = .603).
CONCLUSIONS
AF was as an independent risk factor for postdischarge mortality in patients admitted to hospital for AMI and IS but not in those admitted for DHF.
引言与目的
心房颤动（AF）是多种疾病死亡的独立危险因素。然而，急性失代偿性心力衰竭（DHF）方面发表的数据相互矛盾。我们的目的是研究与因其他原因入院的患者相比，AF对因DHF入院患者死亡率的影响。
方法
这项回顾性队列研究纳入了10年内因DHF、急性心肌梗死（AMI）或缺血性中风（IS）入院的所有患者，中位随访时间为6.2年。
结果
我们纳入了6613例患者（74±11岁；54.6%为男性）；2177例AMI患者，2208例DHF患者和2228例IS患者。因AMI（发生率比，2.48；P<.001）和IS（发生率比，1.84；P<.001）住院的AF患者出院后粗死亡率高于无AF患者。DHF患者未发现差异（发生率比，0.90；P=.12）。在调整模型中，AF不是临床诊断的院内死亡率的独立预测因素。然而，AF成为AMI（HR，1.494；P=.001）和IS（HR，1.426；P<.001）患者出院后死亡率的独立预测因素，但在因DHF入院的患者中不是（HR，0.964；P=.603）。
结论
AF是因AMI和IS入院患者出院后死亡率的独立危险因素，但不是因DHF入院患者的独立危险因素。
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