Hamaguchi Toka, Iwanaga Yoshitaka, Nakai Michikazu, Morita Yusuke, Inoko Moriaki
Cardiovascular Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan.
CJC Open. 2021 Jul 6;3(11):1357-1364. doi: 10.1016/j.cjco.2021.06.018. eCollection 2021 Nov.
Patients undergoing percutaneous coronary intervention (PCI) often develop atrial fibrillation (AF). We investigated the clinical effects of AF status on in-hospital mortality and complications in patients with PCI using a recent large-scale nationwide dataset.
Using a claims-based dataset from 1022 hospitals in Japan for the time period between 2012 and 2016, patients with PCI were identified and classified into 3 groups according to AF status: no AF, prevalent AF before admission, and incident AF after admission. In-hospital mortality, complications, and medical costs were compared in crude and propensity-matched cohorts.
In 659,525 hospitalized patients undergoing PCI, prevalent AF and incident AF were observed in 6.0% and 1.3% patients, respectively; the AF rates increased over 5 years. A greater proportion of older patients and patients with comorbidities had both of these categories of AF; undergoing PCI for acute coronary syndrome was common in incident AF. Both prevalent AF and incident AF were associated with worse crude outcomes and complications during hospitalization. In propensity-matched cohorts, incident AF was associated with a higher in-hospital mortality rate, longer length of stay, higher direct costs, and higher rate of complications, including stroke and acute kidney injury, compared with prevalent AF. These outcomes, except length of in-hospital stay, did not change for either AF status over 5 years.
Prevalent AF and incident AF in patients undergoing PCI were both associated with deteriorating crude outcomes and complications; in particular, incident AF was associated with worse adjusted outcomes and complications. Further efforts are needed to improve patient outcomes in an aging society in which the incidence of AF is increasing.
接受经皮冠状动脉介入治疗（PCI）的患者常发生心房颤动（AF）。我们使用近期大规模全国性数据集，研究了AF状态对PCI患者住院死亡率和并发症的临床影响。
利用日本1022家医院2012年至2016年基于索赔的数据集，识别出PCI患者，并根据AF状态将其分为3组：无AF、入院前存在AF和入院后发生AF。对粗队列和倾向匹配队列中的住院死亡率、并发症和医疗费用进行比较。
在659525例接受PCI的住院患者中，分别有6.0%和1.3%的患者存在入院前AF和入院后AF；AF发生率在5年中有所增加。老年患者和合并症患者中这两类AF的比例更高；急性冠状动脉综合征患者接受PCI在入院后AF中很常见。入院前AF和入院后AF均与住院期间更差的粗结局和并发症相关。在倾向匹配队列中，与入院前AF相比，入院后AF与更高的住院死亡率、更长的住院时间、更高的直接费用以及更高的并发症发生率相关，包括中风和急性肾损伤。除住院时间外这些结局在5年中对任何一种AF状态均无变化。
接受PCI患者的入院前AF和入院后AF均与粗结局和并发症恶化相关；特别是入院后AF与更差的校正结局和并发症相关。在AF发病率不断上升的老龄化社会中，需要进一步努力改善患者结局。
