急性心肌梗死合并心房颤动患者口服抗凝药使用及出院后并发症的近期趋势
Recent Trends in Oral Anticoagulant Use and Post-Discharge Complications Among Atrial Fibrillation Patients with Acute Myocardial Infarction.
作者信息
Kundu Amartya, Day Kevin O, Lessard Darleen M, Gore Joel M, Lubitz Steven A, Yu Hong, Akhter Mohammed W, Fisher Daniel Z, Hayward Robert M, Henninger Nils, Saczynski Jane S, Walkey Allan J, Kapoor Alok, Yarzebski Jorge, Goldberg Robert J, McManus David D
机构信息
Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
出版信息
J Atr Fibrillation. 2018 Feb 28;10(5):1749. doi: 10.4022/jafib.1749. eCollection 2018 Feb.
BACKGROUND
Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI).The CHA2DS2VAScand CHADS2risk scoresare used to identifypatients with AF at risk for strokeand to guide oral anticoagulants (OAC) use, including patients with AMI. However, the epidemiology of AF, further stratifiedaccording to patients' risk of stroke, has not been wellcharacterized among those hospitalized for AMI.
METHODS
We examined trends in the frequency of AF, rates of discharge OAC use, and post-discharge outcomes among 6,627 residents of the Worcester, Massachusetts area who survived hospitalization for AMI at 11 medical centers between 1997 and 2011.
RESULTS
A total of 1,050AMI patients had AF (16%) andthe majority (91%)had a CHA2DS2VAScscore >2.AF rates were highest among patients in the highest stroke risk group.In comparison to patients without AF, patients with AMI and AF in the highest stroke risk category had higher rates of post-discharge complications, including higher 30-day re-hospitalization [27 % vs. 17 %], 30-day post-discharge death [10 % vs. 5%], and 1-year post-discharge death [46 % vs. 18 %] (p < 0.001 for all). Notably, fewerthan half of guideline-eligible AF patientsreceived an OACprescription at discharge. Usage rates for other evidence-based therapiessuch as statins and beta-blockers,lagged in comparison to AMI patients free from AF.
CONCLUSIONS
Our findings highlight the need to enhance efforts towards stroke prevention among AMI survivors with AF.
背景
心房颤动（AF）是急性心肌梗死（AMI）的常见并发症。CHA2DS2VASc和CHADS2风险评分用于识别有中风风险的AF患者，并指导口服抗凝剂（OAC）的使用，包括AMI患者。然而，在因AMI住院的患者中，根据中风风险进一步分层的AF流行病学尚未得到很好的描述。
方法
我们研究了1997年至2011年期间在马萨诸塞州伍斯特地区的11个医疗中心因AMI住院存活的6627名居民中AF的发生频率趋势、出院时OAC的使用率以及出院后的结局。
结果
共有1050名AMI患者发生AF（16%），大多数（91%）的CHA2DS2VASc评分>2。中风风险最高组的患者AF发生率最高。与无AF的患者相比，中风风险最高类别中患有AMI和AF的患者出院后并发症发生率更高，包括30天再住院率更高[27%对17%]、出院后30天死亡率更高[10%对5%]以及出院后1年死亡率更高[46%对18%]（所有p<0.001）。值得注意的是，符合指南标准的AF患者中，出院时接受OAC处方的不到一半。与无AF的AMI患者相比，他汀类药物和β受体阻滞剂等其他循证疗法的使用率较低。
结论
我们的研究结果强调了加强对患有AF的AMI幸存者进行中风预防的努力的必要性。
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