First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Cardiovasc Diabetol. 2021 Feb 11;20(1):40. doi: 10.1186/s12933-021-01232-7.
There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF).
This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM.
In total 1109 AF patients were included, of whom 373 (33.6%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.40 95% confidence intervals [CI] 1.11-1.75), CV mortality (aHR = 1.39, 95% CI 1.07-1.81), sudden cardiac death (aHR = 1.73, 95% CI 1.19-2.52), stroke (aHR = 1.87, 95% CI 1.01-3.45) and the composite outcome of hospitalization or CV death (aHR = 1.27, 95% CI 1.06-1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6-8.2% being independent predictors of increased all-cause mortality, and values < 6.2% predicting significantly decreased all-cause and CV mortality.
The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.
关于糖尿病（DM）和糖化血红蛋白（HbA1c）水平与房颤（AF）患者结局之间的关系，目前数据有限。
本回顾性队列研究纳入了 2015 年 12 月至 2018 年 6 月期间因 AF 初次或再次住院的患者。通过 Kaplan-Meier 曲线和 Cox 回归调整风险比（aHR），计算全因死亡率的主要结局以及心血管（CV）死亡率和 CV 死亡或住院的复合结局的次要结局。进行竞争风险回归分析，以计算 AF 或 HF 住院的中风、大出血、CV 死亡的累积风险，校正全因死亡的竞争风险。拟合样条曲线模型，以调查 AF 和 DM 患者中 HbA1c 值与死亡率之间的关系。
共纳入 1109 例 AF 患者，其中 373 例（33.6%）患有 DM。中位随访 2.6 年后，414 例（37.3%）患者死亡。存在 DM 与全因死亡率（aHR=1.40；95%置信区间 [CI]，1.11-1.75）、CV 死亡率（aHR=1.39；95%CI，1.07-1.81）、心源性猝死（aHR=1.73；95%CI，1.19-2.52）、中风（aHR=1.87；95%CI，1.01-3.45）和住院或 CV 死亡的复合结局（aHR=1.27；95%CI，1.06-1.53）的风险增加相关。在合并 DM 的 AF 患者中，样条曲线显示 HbA1c 水平与结局之间存在正线性关系，7.6-8.2%的 HbA1c 值是全因死亡率增加的独立预测因素，而 <6.2%的 HbA1c 值则预示着全因和 CV 死亡率显著降低。
在 AF 基础上合并 DM 与全因或 CV 死亡率、心源性猝死和发病率增加显著相关。HbA1c 值低于 6.2%与生存率提高独立相关，提示 DM 控制优化可能与 DM 合并 AF 患者的临床结局改善相关。
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