Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Rome, Italy.
Clin Res Cardiol. 2019 Sep;108(9):1034-1041. doi: 10.1007/s00392-019-01432-y. Epub 2019 Feb 13.
Atrial high rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs) are associated with an increased risk of stroke. However, the impact of AHRE on improving stroke risk stratification scheme remains uncertain.
The purpose of this study was to assess the impact of AHRE on prognosis in relation with cardiovascular events and risk stratification.
A total of 856 consecutive patients who had dual-chamber CIEDs implanted were retrospectively analyzed. To detect AHREs, they were monitored for 6 months after CIEDs' implantation and were followed for a mean of 4.0 years for clinical outcomes such as thromboembolism or death.
Overall, 125 (14.6%) of patients developed AHREs within the first 6 months (median age 72.0 years, 39.3% female). Patients with AHREs had a high rate of thromboembolism (2.6%/year) and mortality (3.0%/year). On multivariate analysis, AHRE was significantly associated with increased risk of thromboembolism [hazard ratio (HR) 3.40; 95% confidence interval (CI) 1.38-8.37, P = 0.01] and death (HR 3.47; 95% CI 1.51-7.95; P < 0.01). The predictive abilities of the CHADS and CHADS-VASc scores were modest, with no significant improvements by adding AHRE to those scores. However, the integrated discrimination improvement and net reclassification improvement showed that the addition of AHRE to the CHADS and CHADS-VASc scores statistically improved their predictive ability for the composite outcome.
AHRE was an independent factor associated with increased risk of clinical outcomes. The addition of AHRE to the clinical risk scores significantly improved discrimination for thromboembolism or death.
心脏植入式电子设备（CIED）检测到的心房高频事件（AHREs）与中风风险增加相关。然而，AHRE 对改善中风风险分层方案的影响仍不确定。
本研究旨在评估 AHRE 对与心血管事件和风险分层相关的预后的影响。
回顾性分析了 856 例连续植入双腔 CIED 的患者。为了检测 AHREs，在 CIED 植入后 6 个月内对其进行监测，并平均随访 4.0 年以获得临床结果，如血栓栓塞或死亡。
总体而言，125 例（14.6%）患者在最初 6 个月内出现 AHREs（中位年龄 72.0 岁，39.3%为女性）。AHREs 患者血栓栓塞（2.6%/年）和死亡率（3.0%/年）较高。多变量分析显示，AHRE 与血栓栓塞风险增加显著相关[风险比（HR）3.40；95%置信区间（CI）1.38-8.37，P=0.01]和死亡（HR 3.47；95%CI 1.51-7.95；P<0.01）。CHADS 和 CHADS-VASc 评分的预测能力适中，将 AHRE 添加到这些评分中并不能显著提高其预测能力。然而，综合判别改善和净重新分类改善表明，将 AHRE 添加到 CHADS 和 CHADS-VASc 评分中可显著提高其对复合结局的预测能力。
AHRE 是与临床结局风险增加相关的独立因素。将 AHRE 添加到临床风险评分中可显著提高对血栓栓塞或死亡的预测能力。
