Biasco Luigi, Radovanovic Dragana, Moccetti Marco, Rickli Hans, Roffi Marco, Eberli Franz, Jeger Raban, Moccetti Tiziano, Erne Paul, Pedrazzini Giovanni
Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Rev Esp Cardiol (Engl Ed). 2019 May;72(5):383-391. doi: 10.1016/j.rec.2018.03.002. Epub 2018 Apr 10.
The management and risk stratification of patients with atrial fibrillation (AF) and acute coronary syndromes constitute a challenge. We aimed to evaluate the prognostic impact of AF whether present at admission or occurring during hospitalization for acute coronary syndromes, as well as trends in treatments and outcome.
Data derived from 35 958 patients enrolled between 2004 and 2015 in the AMIS Plus registry were retrospectively analyzed.
Pre-existing AF (pre-AF) was present in 1644 (4.7%) while new-onset AF (new-AF) was evident in 309 (0.8%). Presentation with ST-segment elevation myocardial infarction and need for hemodynamic support was frequent in patients with AF, especially in those with new onset of the arrhythmia. A change of the medical and interventional approaches was observed with a progressive increase in oral anticoagulation prescription and referral for angiography and percutaneous coronary interventions in pre-AF patients. Despite different baseline risk profile and clinical presentations, both AF groups showed high in-hospital and 1-year mortality (in-hospital new-AF vs pre-AF [OR, 0.79; 95%CI, 0.53-1.17; P = .246]; 1-year mortality new-AF vs pre-AF [OR, 0.72; 95%CI, 0.31-1.67; P = .448]) Pre-AF but not new-AF independently predicted in-hospital mortality. While mortality declined over the study period for patients with pre-AF, it remained stable among new-AF patients.
While pre-AF is independently associated with in-hospital mortality, new-AF may reflect a worse hemodynamic impact of the acute coronary syndromes, with the latter ultimately driving the prognosis.
心房颤动（AF）合并急性冠状动脉综合征患者的管理及风险分层是一项挑战。我们旨在评估急性冠状动脉综合征患者入院时即存在的AF或住院期间发生的AF的预后影响，以及治疗和结局的趋势。
回顾性分析2004年至2015年纳入AMIS Plus注册研究的35958例患者的数据。
1644例（4.7%）患者存在既往AF（pre-AF），309例（0.8%）患者出现新发AF（new-AF）。AF患者中，ST段抬高型心肌梗死的表现及血流动力学支持需求较为常见，尤其是新发心律失常的患者。观察到医疗和介入方法有所改变，pre-AF患者口服抗凝治疗的处方以及血管造影和经皮冠状动脉介入治疗的转诊呈逐渐增加趋势。尽管两组患者的基线风险特征和临床表现不同，但AF两组的住院死亡率和1年死亡率均较高（住院期间new-AF与pre-AF相比[比值比（OR），0.79；95%置信区间（CI），0.53 - 1.17；P = 0.246]；1年死亡率new-AF与pre-AF相比[OR，0.72；95%CI，0.31 - 1.67；P = 0.448]）。Pre-AF而非new-AF独立预测住院死亡率。虽然研究期间pre-AF患者的死亡率有所下降，但new-AF患者的死亡率保持稳定。
虽然pre-AF与住院死亡率独立相关，但new-AF可能反映了急性冠状动脉综合征更严重的血流动力学影响，后者最终决定预后。
