Nortamo Santeri, Kenttä Tuomas V, Ukkola Olavi, Huikuri Heikki V, Perkiömäki Juha S
Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
J Cardiovasc Electrophysiol. 2017 Nov;28(11):1269-1274. doi: 10.1111/jce.13304. Epub 2017 Aug 16.
The significance of premature atrial contraction (PAC) count and supraventricular runs (SVR) for the risk of development of new-onset atrial fibrillation (AF) in patients with coronary artery disease (CAD) is not well established.
The Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study cohort consisted of 1,946 patients with CAD who underwent clinical and echocardiographic examinations, 24-hour ambulatory ECG monitoring, and laboratory tests. After excluding patients who were not in sinus rhythm at baseline or were lost from the follow-up, the present study included 1,710 patients. SVR was defined as at least four PACs in a row with a duration <30 seconds.
During a follow-up for an average 5.6 ± 1.5 years, new-onset AF was identified in 143 (8.4%) patients. In the univariate analysis, both SVR and PAC count were associated with the development of new-onset AF. When SVR and PAC count were adjusted with the established AF risk markers of the modified CHARGE-AF model in the Cox multivariate regression analysis, both parameters remained significant predictors of the occurrence of new-onset AF (HR = 2.529, 95 % CI = 1.763-3.628, P ˂ 0.001 and HR = 8.139 for ≥1,409 PACs [the fourth quartile] vs. ≤507 PACs [the first quartile], 95 % CI = 3.967-16.696, P ˂ 0.001, respectively). Together these parameters improved the C-index of the established AF risk model from 0.649 to 0.718, P < 0.001.
Including SVR and PAC count to the established AF risk model improves the discrimination accuracy in predicting AF in patients with CAD.
冠状动脉疾病（CAD）患者中，房性早搏（PAC）计数和室上性心动过速（SVR）对于新发心房颤动（AF）风险的意义尚未明确。
“糖尿病与心血管并发症交叉研究中的创新措施”（ARTEMIS）研究队列由1946例CAD患者组成，这些患者接受了临床和超声心动图检查、24小时动态心电图监测及实验室检查。在排除基线时非窦性心律或失访患者后，本研究纳入1710例患者。SVR定义为连续至少4次PAC，持续时间<30秒。
在平均5.6±1.5年的随访期间，143例（8.4%）患者发生新发AF。单因素分析中，SVR和PAC计数均与新发AF的发生相关。在Cox多因素回归分析中，当用改良的CHARGE-AF模型中已确立的AF风险标志物对SVR和PAC计数进行校正时，这两个参数仍然是新发AF发生的显著预测因子（HR = 2.529，95%CI = 1.763 - 3.628，P < 0.001；≥1409次PAC[第四四分位数]与≤507次PAC[第一四分位数]相比，HR = 8.139，95%CI = 3.967 - 16.696，P < 0.001）。这些参数共同将已确立的AF风险模型的C指数从0.649提高至0.718，P < 0.001。
在已确立的AF风险模型中纳入SVR和PAC计数可提高预测CAD患者AF的鉴别准确性。
