心房颤动中的血栓栓塞事件：外周动脉疾病和冠状动脉疾病之间不同的风险水平和模式。

Thromboembolic events in atrial fibrillation: Different level of risk and pattern between peripheral artery disease and coronary artery disease.

机构信息

Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 33300 Taoyuan City, Taiwan.

Division of Cardiology, Linkou Medical Centre, Chang Gung Memorial Hospital, 33305 Taoyuan City, Taiwan.

出版信息

Arch Cardiovasc Dis. 2021 Mar;114(3):176-186. doi: 10.1016/j.acvd.2020.11.004. Epub 2021 Jan 29.

DOI:10.1016/j.acvd.2020.11.004

PMID:33518472

Abstract

BACKGROUND

The existence of vascular disease in patients with atrial fibrillation (AF) is associated with an increased risk of thromboembolic events. It is unclear whether coronary artery disease (CAD) and/or peripheral artery disease (PAD) have similar presentations and complication rates.

AIM

To investigate thromboembolic events among patients with AF who have CAD, PAD or polyvascular disease.

METHODS

Patients with a new diagnosis of AF without anticoagulation (n=306,386) were identified from the National Health Insurance Research Database in Taiwan (2001-2013). Ischaemic stroke (IS), systemic thromboembolism (STE) and their combination (IS/STE) were compared in four groups (No-CAD/PAD, CAD-only, PAD-only, CAD+PAD), and secondarily in patients with only CAD versus only PAD. Last, we compared propensity score-matched patients with only CAD or PAD with those with CAD and PAD.

RESULTS

There were 185,169 patients without CAD or PAD, 8113 patients with only PAD, 105,715 patients with only CAD, and 7389 patients with CAD and PAD eligible for analysis (mean±SD follow-up 3.2±3.2 years). The incidences of STE and IS/STE differed in the four groups, with the highest in the CAD+PAD group and the lowest in the No-CAD/PAD group. The proportions of IS and STE also varied, with higher proportions of STE in patients with PAD, but higher proportions of IS in patients with CAD. After propensity score matching, the PAD-only group had significantly higher incidences of STE and IS/STE than the CAD-only group, across all levels of CHADS-VASc score. Patients with CAD and PAD had a significantly higher incidence of STE and IS/STE than propensity score-matched patients with CAD or PAD.

CONCLUSIONS

PAD or CAD in patients with AF did not contribute equally to the risk prediction and presentation of IS and STE. Patients with polyvascular disease should be considered at higher risk than those with either condition.

摘要

背景

患有心房颤动（AF）的患者存在血管疾病与血栓栓塞事件风险增加相关。尚不清楚冠状动脉疾病（CAD）和/或外周动脉疾病（PAD）是否具有相似的表现和并发症发生率。

目的

研究伴有 CAD、PAD 或多血管疾病的 AF 患者中的血栓栓塞事件。

方法

从台湾全民健康保险研究数据库（2001-2013 年）中确定了新诊断为 AF 且未接受抗凝治疗的患者（n=306,386）。在四个组（无 CAD/PAD、CAD 仅、PAD 仅、CAD+PAD）中比较了缺血性卒中（IS）、全身性血栓栓塞（STE）及其组合（IS/STE），其次比较了仅 CAD 与仅 PAD 的患者。最后，比较了仅 CAD 或 PAD 与 CAD 和 PAD 的患者的倾向评分匹配患者。

结果

共有 185,169 例无 CAD 或 PAD、8113 例仅 PAD、105,715 例仅 CAD 和 7389 例 CAD 和 PAD 的患者符合分析条件（平均随访 3.2±3.2 年）。四组之间的 STE 和 IS/STE 发生率不同，CAD+PAD 组最高，无 CAD/PAD 组最低。IS 和 STE 的比例也不同，PAD 组的 STE 比例较高，但 CAD 组的 IS 比例较高。经倾向评分匹配后，在所有 CHADS-VASc 评分水平上，PAD 仅组的 STE 和 IS/STE 发生率均显著高于 CAD 仅组。CAD 和 PAD 的患者的 STE 和 IS/STE 发生率明显高于 CAD 或 PAD 的倾向评分匹配患者。