新发心房颤动在急性心肌梗死期间的长期预后：抗血栓治疗策略的影响。

Long-term prognosis of de novo atrial fibrillation during acute myocardial infarction: the impact of anti-thrombotic treatment strategies.

机构信息

Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

出版信息

Eur Heart J Cardiovasc Pharmacother. 2021 May 23;7(3):189-195. doi: 10.1093/ehjcvp/pvaa027.

DOI:10.1093/ehjcvp/pvaa027

PMID:32289167

Abstract

AIMS

While the prognosis of patients presenting with de novo atrial fibrillation (AF) during the acute phase of myocardial infarction has been controversially discussed, it seems intuitive that affected individuals have an increased risk for both thrombo-embolic events and mortality. However, profound data on long-term outcome of this highly vulnerable patient population are not available in current literature. Therefore, we aimed to investigate the impact of de novo AF and associated anti-thrombotic treatment strategies on the patient outcome from a long-term perspective.

METHODS AND RESULTS

Patients presenting with acute myocardial infarction, treated at the Medical University of Vienna, were enrolled within a clinical registry and screened for the development of de novo AF. After discharge, participants were followed prospectively over a median time of 8.6 years. Primary study endpoint was defined as cardiovascular mortality. Out of 1372 enrolled individuals 149 (10.9%) developed de novo AF during the acute phase of acute myocardial infarction. After a median follow-up time of 8.6 years, a total of 418 (30.5%) died due to cardiovascular causes, including 93 (62.4%) in the de novo AF subgroup. We found that de novo AF was significantly associated with long-term cardiovascular mortality with an adjusted HR of 1.45 (95% CI 1.19-2.57; P < 0.001). While patients with de novo AF were less likely to receive a triple anti-thrombotic therapy as compared to patients with pre-existing AF at time of discharge, this therapeutic approach showed a strong and inverse association with mortality in de novo AF, with an adj. HR of 0.86 (95% CI 0.45-0.92; P = 0.012).

CONCLUSION

De novo AF was independently associated with a poor prognosis with a 67% increased risk of long-term cardiovascular mortality. Intensified anti-thrombotic treatment in this high-risk patient population might be considered.

摘要

目的

虽然新发心房颤动（AF）患者在心肌梗死急性期的预后存在争议，但似乎可以直观地认为，此类患者发生血栓栓塞事件和死亡的风险均增加。然而，目前的文献中尚无关于此类高危人群长期预后的深入数据。因此，我们旨在从长期角度探讨新发 AF 及其相关抗栓治疗策略对患者结局的影响。

方法和结果

在维也纳医科大学，我们在临床注册登记处入组急性心肌梗死患者，并筛查新发 AF 的发生情况。出院后，对患者进行了中位时间为 8.6 年的前瞻性随访。主要研究终点定义为心血管死亡率。在纳入的 1372 名患者中，有 149 名（10.9%）在急性心肌梗死急性期发生新发 AF。中位随访 8.6 年后，共有 418 名（30.5%）死于心血管原因，新发 AF 亚组中共有 93 名（62.4%）患者死亡。我们发现，新发 AF 与长期心血管死亡率显著相关，校正后 HR 为 1.45（95%CI 1.19-2.57；P<0.001）。与新发 AF 时已存在 AF 的患者相比，新发 AF 患者出院时接受三联抗栓治疗的可能性较小，但这种治疗方法与新发 AF 患者的死亡率呈强烈的负相关，校正后 HR 为 0.86（95%CI 0.45-0.92；P=0.012）。