[新型冠状病毒肺炎患者的心房颤动。CHADS-VASc评分的效用：国际HOPE新型冠状病毒肺炎注册研究分析]

[Atrial fibrillation in patients with COVID-19. Usefulness of the CHADS-VASc score: an analysis of the international HOPE COVID-19 registry].

作者信息

Uribarri Aitor, Núñez-Gil Iván J, Aparisi Álvaro, Arroyo-Espliguero Ramón, Maroun Eid Charbel, Romero Rodolfo, Becerra-Muñoz Víctor M, Feltes Gisela, Molina María, García-Aguado Marcos, Cerrato Enrico, Capel-Astrua Thamar, Alfonso-Rodríguez Emilio, Castro-Mejía Alex F, Raposeiras-Roubín Sergio, Espejo Carolina, Pérez-Solé Nerea, Bardají Alfredo, Marín Francisco, Fabregat-Andrés Óscar, D'ascenzo Fabrizio, Santoro Francesco, Akin Ibrahim, Estrada Vicente, Fernández-Ortiz Antonio, Macaya Carlos

机构信息

Servicio de Cardiología, Hospital Clinico Universitario de Valladolid, Valladolid, España.

Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.

出版信息

Rev Esp Cardiol. 2021 Jul;74(7):608-615. doi: 10.1016/j.recesp.2020.12.014. Epub 2021 Mar 2.

DOI:10.1016/j.recesp.2020.12.014

PMID:33678938

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7923850/

Abstract

INTRODUCTION AND OBJECTIVES

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Atrial fibrillation (AF) is common in acute situations, where it is associated with more complications and higher mortality.

METHODS

Analysis of the international HOPE registry (NCT04334291). The objective was to assess the prognostic information of AF in COVID-19 patients. A multivariate analysis and propensity score matching were performed to assess the relationship between AF and mortality. We also evaluated the impact on mortality and embolic events of the CHADS-VASc score in these patients.

RESULTS

Among 6217 patients enrolled in the HOPE registry, 250 had AF (4.5%). AF patients had a higher prevalence of cardiovascular risk factors and comorbidities. After propensity score matching, these differences were attenuated. Despite this, patients with AF had a higher incidence of in-hospital complications such as heart failure (19.3% vs 11.6%, = .021) and respiratory insufficiency (75.9% vs 62.3%, = .002), as well as a higher 60-day mortality rate (43.4% vs 30.9%, = .005). On multivariate analysis, AF was independently associated with higher 60-day mortality (hazard ratio, 1.234; 95%CI, 1.003-1.519). CHADS-VASc score acceptably predicts 60-day mortality in COVID-19 patients (area ROC, 0.748; 95%CI, 0.733-0.764), but not its embolic risk (area ROC, 0.411; 95%CI, 0.147-0.675).

CONCLUSIONS

AF in COVID-19 patients is associated with a higher number of complications and 60-day mortality. The CHADS-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk.

摘要

引言与目的

2019冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2引起。心房颤动（AF）在急性情况下很常见，与更多并发症和更高死亡率相关。

方法

对国际HOPE注册研究（NCT04334291）进行分析。目的是评估AF在COVID-19患者中的预后信息。进行多因素分析和倾向得分匹配以评估AF与死亡率之间的关系。我们还评估了CHADS-VASc评分对这些患者死亡率和栓塞事件的影响。

结果

在HOPE注册研究纳入的6217例患者中，250例患有AF（4.5%）。AF患者心血管危险因素和合并症的患病率更高。倾向得分匹配后，这些差异有所减弱。尽管如此，AF患者住院并发症如心力衰竭（19.3%对11.6%，P = 0.021）和呼吸功能不全（75.9%对62.3%，P = 0.002）的发生率更高，60天死亡率也更高（43.4%对30.9%，P = 0.005）。多因素分析显示，AF与60天死亡率较高独立相关（风险比，1.234；95%CI，1.003 - 1.519）。CHADS-VASc评分可较好地预测COVID-19患者的60天死亡率（ROC曲线下面积，0.748；95%CI，0.733 - 0.764），但不能预测其栓塞风险（ROC曲线下面积，0.411；95%CI，0.147 - 0.675）。