Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Am Heart J. 2019 Jul;213:81-90. doi: 10.1016/j.ahj.2019.04.007. Epub 2019 Apr 24.
Treatment patterns and outcomes of individuals with vascular disease who have new-onset atrial fibrillation (AF) are not well characterized.
Among patients with new-onset AF, we analyzed treatment and outcomes in those with or without vascular disease in the ORBIT-AF II registry. Vascular disease was defined as coronary disease with or without myocardial infarction (MI) or revascularization, or peripheral artery disease. The primary outcomes included major adverse cardiovascular or neurological events (MACNE) and major bleeding. Cox proportional hazard models were used to adjust the difference in patient characteristics.
Overall 1920 of 6203 (31.0%) of new-onset AF had vascular disease. In patients with vascular disease, 62.2% of those were treated with direct oral anticoagulants (DOACs) and 23.4% with warfarin. Dual therapy and triple therapy were used in 36.9% and 4.9%, respectively. Vascular disease patients had increased risk of MACNE (adjusted hazard ratio [aHR] 1.83 [95%CIs 1.32-2.55]), but not major bleeding (aHR 1.24 [0.95-1.63]). Among patients with vascular disease, relative to those on warfarin, those treated with DOACs had similar risk for MACNE (aHR 1.20 [0.77-1.87]) but lower risks for bleeding, although it did not reach statistical significance (aHR 0.70 [0.43-1.15]). Concomitant antiplatelet therapy was associated with higher bleeding (aHR 2.27 [1.38-3.73]) with no apparent reduction in MACNE (aHR 1.50 [1.00-2.25]).
Most patients with AF and vascular disease were managed with oral anticoagulation. About half of them were also treated with concomitant antiplatelet therapy, which was associated with increased risk of bleeding, without evidence of improved cardiovascular outcomes.
患有新发心房颤动（AF）的血管疾病患者的治疗模式和结局尚不清楚。
在 ORBIT-AF II 登记研究中，我们分析了新发 AF 患者中伴有或不伴有血管疾病患者的治疗和结局。血管疾病定义为伴有或不伴有心肌梗死（MI）或血运重建的冠状动脉疾病或外周动脉疾病。主要复合心血管或神经不良事件（MACNE）和主要出血是主要结局。Cox 比例风险模型用于调整患者特征的差异。
共有 6203 例新发 AF 患者中有 1920 例（31.0%）患有血管疾病。在患有血管疾病的患者中，62.2%接受了直接口服抗凝剂（DOAC）治疗，23.4%接受了华法林治疗。双重治疗和三重治疗分别占 36.9%和 4.9%。血管疾病患者发生 MACNE 的风险增加（校正后的危险比[aHR]为 1.83[95%CI 1.32-2.55]），但大出血风险无增加（aHR 1.24[0.95-1.63]）。在患有血管疾病的患者中，与华法林相比，接受 DOAC 治疗的患者发生 MACNE 的风险相似（aHR 1.20[0.77-1.87]），但出血风险较低，尽管未达到统计学意义（aHR 0.70[0.43-1.15]）。同时使用抗血小板治疗与出血风险增加相关（aHR 2.27[1.38-3.73]），但 MACNE 无明显降低（aHR 1.50[1.00-2.25]）。
大多数伴有 AF 和血管疾病的患者接受了口服抗凝治疗。其中约一半患者还同时接受了抗血小板治疗，这与出血风险增加相关，同时无心血管结局改善的证据。
