Institute of Applied Health Research, 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. 2020 Jan;109(1):96-102. doi: 10.1007/s00392-019-01493-z. Epub 2019 May 29.
Patients with atrial high-rate episodes (AHREs) are at higher risk of thromboembolic events and mortality. The risk of major adverse cardiovascular events (MACE) in these patients is unknown.
To investigate the risk of MACE in patients implanted with cardiac implantable electronic devices (CIEDs) developing AHREs METHODS AND RESULTS: We included 852 consecutive patients undergoing CIEDs implantation. Primary outcome was a composite endpoint of MACEs occurring after AHREs ≥ 5 min. AHRE was defined as > 175 bpm and lasting ≥ 5 min. We also performed a subgroup analysis in patients with the longest AHRE lasting ≥ 24 h. Cox regression analysis with time-dependent covariates was used to investigate the relationship between AHREs and MACEs. Mean age was 70.0 ± 13.6 years, and 39.3% were women: 325 patients developed AHREs ≥ 5 min [incidence rate (IR) 13.1% year 95% confidence interval (CI) 11.7-14.6] and 124 patients developed AHREs ≥ 24 h (IR 3.7%/year 95% CI 3.1-4.5). During a median follow-up of 37.0 months (IQR 19.0-64.3, 316,132 patient-years), 152 MACEs occurred (IR 4.85%/year, 95% CI 4.11-5.68). The IR of MACE occurring after AHREs onset was higher in patients developing AHREs ≥ 24 h (IR 1.13%/year) than AHREs ≥ 5 min (IR 0.63%/year, p = 0.030). Multivariable Cox regression analysis showed that AHREs ≥ 5 min (HR 1.788, 95% CI 1.247-2.562, p = 0.002), diabetes (HR 1.909, 95% CI 1.358-2.683, p < 0.001), heart failure (HR 2.203, 95% CI 1.527-3.178, p < 0.001), and coronary artery disease (HR 1.862, 95% CI 1.293-2.681, p = 0.001) were associated to MACE. This association was even stronger for AHREs ≥ 24 h (HR 2.390, 95% CI 1.481-3.857, p < 0.001).
Patients implanted with CIEDs developing AHREs show a significant risk for MACE, which is dependent on AHREs burden. Cardiovascular prevention strategies in this patient population are warranted.
患有房性心动过速事件（AHREs）的患者发生血栓栓塞事件和死亡的风险较高。这些患者发生主要不良心血管事件（MACE）的风险尚不清楚。
研究植入心脏植入式电子设备（CIEDs）的患者发生 AHREs 后发生 MACE 的风险。
我们纳入了 852 例连续接受 CIED 植入的患者。主要结局是 AHREs 持续时间≥5 分钟后发生的 MACE 复合终点。AHRE 定义为>175 bpm 且持续时间≥5 分钟。我们还对持续时间最长的 AHRE 持续时间≥24 小时的患者进行了亚组分析。使用具有时间依赖性协变量的 Cox 回归分析来研究 AHREs 与 MACEs 之间的关系。平均年龄为 70.0±13.6 岁，39.3%为女性：325 例患者发生 AHREs 持续时间≥5 分钟[发生率（IR）为 13.1%/年，95%置信区间（CI）为 11.7-14.6]，124 例患者发生 AHREs 持续时间≥24 小时（IR 为 3.7%/年，95%CI 为 3.1-4.5）。在中位数为 37.0 个月（IQR 19.0-64.3，316132 患者年）的随访期间，发生了 152 例 MACE（IR 为 4.85%/年，95%CI 为 4.11-5.68）。发生 AHREs 后发生 MACE 的 IR 在发生 AHREs 持续时间≥24 小时的患者中（IR 为 1.13%/年）高于发生 AHREs 持续时间≥5 分钟的患者（IR 为 0.63%/年，p=0.030）。多变量 Cox 回归分析显示，AHREs 持续时间≥5 分钟（HR 1.788，95%CI 1.247-2.562，p=0.002）、糖尿病（HR 1.909，95%CI 1.358-2.683，p<0.001）、心力衰竭（HR 2.203，95%CI 1.527-3.178，p<0.001）和冠状动脉疾病（HR 1.862，95%CI 1.293-2.681，p=0.001）与 MACE 相关。对于 AHREs 持续时间≥24 小时的患者，这种相关性更强（HR 2.390，95%CI 1.481-3.857，p<0.001）。
植入 CIED 的患者发生 AHREs 后发生 MACE 的风险显著增加，这取决于 AHREs 的负担。需要在该患者人群中实施心血管预防策略。
