Department of Cardiology, Division of Cardiology and Cardiovascular Surgery, 6th Medical Center of PLA General Hospital, Beijing, China.
Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Acta Cardiol. 2022 Jun;77(4):360-365. doi: 10.1080/00015385.2021.1950367. Epub 2021 Aug 6.
This study aimed to evaluate predictors for adverse cardiovascular outcomes in patients with atrial fibrillation (AF) undergoing coronary stenting.
We retrospectively recruited consecutive patients with previously documented non-valvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. Major adverse cardiac/cerebrovascular events (MACCE) were a composite of all-cause death, non-fatal myocardial infarction, repeat revascularization, and ischaemic stroke/systemic thromboembolism (IS/STE). Major bleeding referred to grade 2 or higher of Bleeding Academic Research Consortium criteria.
A total of 2394 patients (men: 72.3% women: 27.7%, median age: 67 years) were included. The CHADS-VASc and HAS-BLED were 3.6 ± 1.6 and 1.9 ± 0.7, respectively. The median follow-up duration was 36.2 months. There were 230 (9.6%) deaths, 96 (4.0%) IS/STE, 426 (17.8%) MACCE, and 72 (3.0%) major bleeding. Multivariate Cox regression yielded predictive models for (1) all-cause death: diabetes, prior myocardial infarction, chronic kidney disease (CKD), ST-segment elevation myocardial infarction (STEMI) at presentation, heart failure, no use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins; (2) IS/STE: advanced age, prior history of ischaemic stroke and intracranial haemorrhage; (3) MACCE: prior history of myocardial infarction and ischaemic stroke, CKD, STEMI, heart failure, and no statin use; (4) major bleeding: prior major bleeding, prior myocardial infarction, CKD and use of oral anticoagulants.
Chinese patients with AF and coronary stenting had high mortality and incidence of MACCE. We compiled separate predictive models for all-cause death, IS/STE, MACCE, and major bleeding.
本研究旨在评估接受冠状动脉支架置入术的心房颤动（AF）患者不良心血管结局的预测因素。
我们回顾性招募了 2010 年 1 月至 2015 年 6 月期间在中国北京的 12 家医院接受冠状动脉支架置入术的有先前记录的非瓣膜性 AF 病史的连续患者。主要不良心脏/脑血管事件（MACCE）是指全因死亡、非致死性心肌梗死、再次血运重建和缺血性卒中和全身性血栓栓塞（IS/STE）的复合事件。主要出血是指根据 Bleeding Academic Research Consortium 标准达到 2 级或更高的出血。
共纳入 2394 例患者（男性：72.3%，女性：27.7%，中位年龄：67 岁）。CHADS-VASc 和 HAS-BLED 评分分别为 3.6±1.6 和 1.9±0.7。中位随访时间为 36.2 个月。有 230 例（9.6%）死亡，96 例（4.0%）IS/STE，426 例（17.8%）MACCE 和 72 例（3.0%）大出血。多变量 Cox 回归得出了以下预测模型：（1）全因死亡：糖尿病、既往心肌梗死、慢性肾脏病（CKD）、ST 段抬高型心肌梗死（STEMI）、心力衰竭、未使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和他汀类药物；（2）IS/STE：高龄、既往缺血性卒中和颅内出血史；（3）MACCE：既往心肌梗死和缺血性卒中史、CKD、STEMI、心力衰竭和未使用他汀类药物；（4）大出血：既往大出血、既往心肌梗死、CKD 和使用口服抗凝剂。
中国 AF 合并冠状动脉支架置入术的患者死亡率和 MACCE 发生率较高。我们为全因死亡、IS/STE、MACCE 和大出血分别编制了预测模型。
