心房颤动患者外周动脉和冠状动脉疾病与心血管事件的关系。

Relationship of peripheral and coronary artery disease to cardiovascular events in patients with atrial fibrillation.

机构信息

I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.

I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.

出版信息

Int J Cardiol. 2018 Mar 15;255:69-73. doi: 10.1016/j.ijcard.2017.12.076. Epub 2017 Dec 24.

DOI:10.1016/j.ijcard.2017.12.076

PMID:29290420

Abstract

BACKGROUND

To investigate the impact of concomitant asymptomatic peripheral artery disease (PAD) and pre-existing coronary artery disease (CAD) on cardiovascular events (CVEs) in atrial fibrillation (AF) patients.

METHODS

Prospective multicenter study including 1138 anticoagulated AF patients. PAD was diagnosed by can ankle-brachial index (ABI)≤0.9, and CAD as a documented myocardial infarction (MI) or cardiac revascularization. The cohort was divided into 4 groups: group 0 (n=717) with no previous CAD and ABI >0.9; group 1 (n=168) no previous CAD and ABI≤0.9; group 2 (n=183) previous CAD and ABI >0.9: and group 3 (n=70) previous CAD and ABI≤0.9. The primary endpoint was a composite of CVEs.

RESULTS

Mean age was 72.6years and 41.3% were female. History of CAD was present in 253 (22.2%) patients, and 238 (20.9%) had an ABI≤0.9. Patients with previous CAD were more likely to have a low ABI compared to those without (OR:1.6, 95%CI 1.2-2.3, P=0.003). Median follow-up was 35.9months (IQR 19.2-57.2, 3819 patient-years), and 145 CVEs were recorded (3.8%/year 95%CI 3.2-4.5). Survival analysis showed a progressive increase in the rate of CVEs in the four groups (log-rank test P<0.001). Multivariable Cox regression analysis showed that as compared to group 0, group 1 (HR:1.8, 95%CI 1.1-2.9, P=0.01), group 2 (HR:2.2, 95%CI 1.4-3.4, P=0.001) and group 3 (HR:2.4, 95%CI 1.4-4.4, P=0.003) were associated with progressive greater risk of CVEs.

CONCLUSION

Patients with concomitant CAD and asymptomatic PAD are at high risk of CVEs, with a progressive risk with vascular disease burden where PAD was associated with CAD.

摘要

背景

本研究旨在探讨无症状外周动脉疾病（PAD）合并并存的冠状动脉疾病（CAD）对心房颤动（AF）患者心血管事件（CVE）的影响。

方法

这是一项前瞻性多中心研究，共纳入 1138 例接受抗凝治疗的 AF 患者。通过踝臂指数（ABI）≤0.9 诊断 PAD，通过已确诊的心肌梗死（MI）或心脏血运重建诊断 CAD。该队列分为 4 组：组 0（n=717）无既往 CAD 和 ABI>0.9；组 1（n=168）无既往 CAD 和 ABI≤0.9；组 2（n=183）既往 CAD 和 ABI>0.9；组 3（n=70）既往 CAD 和 ABI≤0.9。主要终点是 CVE 的复合结局。

结果

平均年龄为 72.6 岁，41.3%为女性。253 例（22.2%）患者有 CAD 病史，238 例（20.9%）ABI≤0.9。与无 CAD 病史的患者相比，既往有 CAD 病史的患者更可能有较低的 ABI（比值比：1.6，95%CI 1.2-2.3，P=0.003）。中位随访时间为 35.9 个月（IQR 19.2-57.2，3819 患者年），记录到 145 例 CVE（3.8%/年，95%CI 3.2-4.5）。生存分析显示，四组之间 CVE 的发生率呈逐渐增加趋势（对数秩检验 P<0.001）。多变量 Cox 回归分析显示，与组 0 相比，组 1（HR：1.8，95%CI 1.1-2.9，P=0.01）、组 2（HR：2.2，95%CI 1.4-3.4，P=0.001）和组 3（HR：2.4，95%CI 1.4-4.4，P=0.003）与 CVE 的风险逐渐增加相关。