Su Kuan-Jen, Lin Wen-Yu, Lin Wei-Shiang, Lin Chin-Sheng, Cheng Cheng-Chung, Liou Jun-Ting, Ho Chen-Hsuan, Yang Shih-Ping, Cheng Shu-Meng, Hung Yuan
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan.
Acta Cardiol Sin. 2021 Mar;37(2):155-165. doi: 10.6515/ACS.202103_37(2).20200915A.
New-onset atrial fibrillation (NOAF) in acute coronary syndrome (ACS) may be associated with a poor prognosis. However, whether restoring sinus rhythm (SR) at discharge in patients with ACS improves outcomes remains unknown.
A total of 552 patients with ACS at an emergency department during 2011-2016 were enrolled. According to documented electrocardiography at admission and medical records, the patients were classified into without atrial fibrillation (WAF), NOAF, and prior atrial fibrillation (PAF) groups. Major adverse events (MAEs) were defined as cardiac death, recurrent myocardial infarction, heart failure requiring hospitalization, target lesion revascularization, and stroke. The mean follow-up period of MAEs was 25 ± 15 months.
Compared with the NOAF and PAF groups, the WAF group was younger and had a significantly lower heart rate, prior stroke rate, CHADS-VASc score, and lower Global Registry of Acute Coronary Events (GRACE) score in the emergency department (p < 0.001). The patients in the NOAF group had the highest incidence of MAEs (p < 0.001) during follow-up, and those whose SR was restored at discharge had a lower MAE rate than those with AF at discharge (p = 0.001). In multivariable analysis, prior myocardial infarction, GRACE score, use of beta-blockers, and restoring SR at discharge were independent predictors of MAEs in the NOAF group.
The patients with ACS who presented with NOAF had worse outcomes than those with PAF or WAF. The patients with NOAF whose rhythm was restored to SR at discharge were associated with better outcomes than those with AF at discharge.
急性冠状动脉综合征（ACS）患者新发房颤（NOAF）可能与预后不良相关。然而，ACS患者出院时恢复窦性心律（SR）是否能改善预后仍不清楚。
纳入2011年至2016年期间在急诊科就诊的552例ACS患者。根据入院时记录的心电图和病历，将患者分为无房颤（WAF）、NOAF和既往房颤（PAF）组。主要不良事件（MAE）定义为心源性死亡、再发心肌梗死、需住院治疗的心力衰竭、靶病变血运重建和卒中。MAE的平均随访期为25±15个月。
与NOAF组和PAF组相比，WAF组患者更年轻，心率、既往卒中发生率、CHADS-VASc评分以及急诊科全球急性冠状动脉事件注册（GRACE）评分显著更低（p<0.001）。NOAF组患者随访期间MAE发生率最高（p<0.001），出院时恢复SR的患者MAE发生率低于出院时仍有房颤的患者（p=0.001）。在多变量分析中，既往心肌梗死、GRACE评分、β受体阻滞剂的使用以及出院时恢复SR是NOAF组MAE的独立预测因素。
出现NOAF的ACS患者比PAF或WAF患者预后更差。出院时心律恢复为SR的NOAF患者比出院时仍有房颤的患者预后更好。
