Hua C, Jiang C, He L, Jia Z X, Lyu W H, Tang R B, Sang C H, Long D Y, Dong J Z, Ma C S, Du X
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Apr 24;49(4):353-359. doi: 10.3760/cma.j.cn112148-20201213-01033.
To investigate the causes of death and predictors in patients with nonvalvular atrial fibrillation (AF) undergoing anticoagulation therapy. Consecutive anticoagulated nonvalvular AF patients were recruited from the China Atrial Fibrillation Registry (China-AF) Study from August 2011 to December 2018. After exclusion of patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, or loss of follow-up within 1 year, 2 248 patients were included in this analysis. Enrolled patients were followed up were followed up for 3 and 6 months, and then every 6 months. The primary endpoint was death, including cardiovascular death, non-cardiovascular death and undetermined death. The patients were divided into survival group and death group according to the survival status after follow-up. Clinical information such as age and sex was collected. Cox proportional hazards regression was performed to identify associated risk factors for all-cause mortality, and Fine-Gray competing risk model was used to identify associated risk factors for cardiovascular mortality. A total of 2 248 patients with atrial fibrillation receiving anticoagulant therapy died over a mean follow-up of (42±24) months, mean age was (67±10) years old and 41.1% (923/2 248) patients were female. The mortality rate was 2.8 deaths per 100 patient-years. The most common cause of death was cardiovascular deaths, accounted for 55.0% (120/218). Worsening heart failure was the most common cause of cardiovascular deaths (18.3% (40/218)), followed by bleeding events (12.9% (28/218)) and ischemic stroke (8.7% (19/218)). Multivariate Cox regression analysis showed that age ( = 1.05, 95% 1.04-1.07, <0.001), anemia ( = 1.81, 95% 1.02-3.18, = 0.041), heart failure (=2.40, 95% 1.75-3.30, <0.001), ischemic stroke/transient ischemic attack (TIA)( = 1.59, 95% 1.21-2.13, = 0.001) and myocardial infarction ( = 2.93, 95% 1.79-4.81, <0.001) were independently associated with all-cause death. Fine-Gray competing risk model showed that age (=1.05, 95% 1.02-1.08, <0.001), heart failure (=2.81, 95% 1.79-4.39, <0.001), ischemic stroke/TIA (=1.50, 95% 1.02-2.22, =0.041) and myocardial infarction (=3.31, 95% 1.72-6.37, <0.001) were independently associated with cardiovascular death. In anticoagulated nonvalvular AF patients, ischemic stroke represents only a small subset of deaths, whereas worsening heart failure is the most common cause of cardiovascular deaths. Heart failure, ischemic stroke/TIA, and myocardial infarction are associated with increased mortality.
探讨接受抗凝治疗的非瓣膜性心房颤动（房颤）患者的死亡原因及预测因素。2011年8月至2018年12月期间，从中国房颤注册研究（China-AF）中招募连续接受抗凝治疗的非瓣膜性房颤患者。排除肥厚型心肌病、扩张型心肌病患者或1年内失访的患者后，2248例患者纳入本分析。对入选患者进行3个月和6个月的随访，之后每6个月随访一次。主要终点为死亡，包括心血管死亡、非心血管死亡和死因不明的死亡。根据随访后的生存状态将患者分为生存组和死亡组。收集年龄、性别等临床信息。采用Cox比例风险回归分析确定全因死亡率的相关危险因素，采用Fine-Gray竞争风险模型确定心血管死亡率的相关危险因素。共有2248例接受抗凝治疗的房颤患者在平均（42±24）个月的随访期内死亡，平均年龄为（67±10）岁，41.1%（923/2248）为女性。死亡率为每100患者年2.8例死亡。最常见的死亡原因是心血管死亡，占55.0%（120/218）。心力衰竭恶化是心血管死亡最常见的原因（18.3%（40/218）），其次是出血事件（12.9%（28/218））和缺血性卒中（8.7%（19/218））。多因素Cox回归分析显示，年龄（=1.05，95%可信区间1.04 - 1.07，P<0.001）、贫血（=1.81，95%可信区间1.02 - 3.18；P = 0.041）、心力衰竭（=2.40，95%可信区间1.75 - 3.30，P<0.001）、缺血性卒中/短暂性脑缺血发作（TIA）（=1.59，95%可信区间1.21 - 2.13，P = 0.001）和心肌梗死（=2.93，95%可信区间1.79 - 4.81，P<0.001）与全因死亡独立相关。Fine-Gray竞争风险模型显示，年龄（=1.05，95%可信区间1.02 - 1.08，P<0.001）、心力衰竭（=2.81，95%可信区间1.79 - 4.39，P<0.001）、缺血性卒中/TIA（=1.50，95%可信区间1.02 - 2.22，P = 0.041）和心肌梗死（=3.31，95%可信区间1.72 - 6.37，P<0.001）与心血管死亡独立相关。在接受抗凝治疗的非瓣膜性房颤患者中，缺血性卒中仅占死亡的一小部分，而心力衰竭恶化是心血管死亡最常见的原因。心力衰竭、缺血性卒中/TIA和心肌梗死与死亡率增加相关。
