Duke University Medical Center, DCRI, North Pavilion, 2400 Pratt Street, Durham, NC 27705, USA.
Duke Clinical Research Institute, DCRI, North Pavilion, 2400 Pratt Street, Durham, NC 27705, USA.
Eur Heart J Qual Care Clin Outcomes. 2017 Jul 1;3(3):192-197. doi: 10.1093/ehjqcco/qcx004.
The presence of cancer can complicate treatment choices for patients with atrial fibrillation (AF) increasing both the risk of thrombotic and bleeding events.
Using data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we aimed to characterize AF patients with cancer, to describe their management and to assess the association between cancer and cardiovascular (CV) outcomes. Among 9749 patients, 23.8% had history of cancer (57% solid malignancy, 1.3% leukaemia, 3.3% lymphoma, 40% other type, and 2.2% metastatic cancer). Patients with history of cancer were older, more likely to have CV disease, CV risk factors, and prior gastrointestinal bleeding. No difference in antiarrhythmic and antithrombotic therapy was observed between those with and without cancer. Patients with history of cancer had a significantly higher risk of death (7.8 vs. 4.9 deaths per 100 patient-years follow-up, P = 0.0003) mainly driven by non-CV death (4.2 vs. 2.4 per 100 patient-years follow-up; P = 0.0004) and higher risk of major bleeding (5.1 vs. 3.5 per 100 patient-years follow-up; P = 0.02) compared with non-cancer patients; no differences were observed in risks of strokes/non-central nervous system embolism (1.96 vs. 1.48, P = 0.74) and CV death (2.89 vs. 2.07, P = 0.35) between the two groups.
A history of cancer is common among AF patients with up to one in four patients having both. Antithrombotic therapy, rates of cerebrovascular accident, other thrombotic events and cardiac death were similar in AF patients with or without a history of cancer. Patients with cancer, however, were at higher risk of major bleeding and non-CV death.
癌症的存在会使房颤（AF）患者的治疗选择复杂化，增加血栓形成和出血事件的风险。
利用 Outcomes Registry for Better Informed Treatment of Atrial Fibrillation 数据，我们旨在描述癌症合并 AF 患者的特征，描述他们的治疗方法，并评估癌症与心血管（CV）结局之间的关系。在 9749 例患者中，23.8%有癌症病史（57%为实体恶性肿瘤，1.3%为白血病，3.3%为淋巴瘤，40%为其他类型，2.2%为转移性癌症）。有癌症病史的患者年龄较大，更有可能患有 CV 疾病、CV 危险因素和既往胃肠道出血。有癌症病史和无癌症病史的患者在抗心律失常和抗血栓治疗方面无差异。有癌症病史的患者死亡风险显著升高（每 100 患者年随访 7.8 例死亡 vs. 4.9 例死亡，P=0.0003），主要是由非 CV 死亡（每 100 患者年随访 4.2 例死亡 vs. 2.4 例死亡，P=0.0004）和大出血风险升高（每 100 患者年随访 5.1 例出血 vs. 3.5 例出血，P=0.02）所致，与非癌症患者相比，中风/非中枢神经系统栓塞（1.96 例 vs. 1.48 例，P=0.74）和 CV 死亡（2.89 例 vs. 2.07 例，P=0.35）的风险无差异。
AF 患者中癌症病史较为常见，多达四分之一的患者同时存在。有或无癌症病史的 AF 患者的抗血栓治疗、中风、其他血栓形成事件和心脏死亡发生率相似。然而，癌症患者大出血和非 CV 死亡的风险更高。
