房颤模式与死亡率和心血管事件的相关性：MISOAC-AF 试验的启示。

Associations of Atrial Fibrillation Patterns With Mortality and Cardiovascular Events: Implications of the MISOAC-AF Trial.

机构信息

First Department of Cardiology, 37788AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Laboratory of Computing, 37788Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.

出版信息

J Cardiovasc Pharmacol Ther. 2022 Jan-Dec;27:10742484211069422. doi: 10.1177/10742484211069422.

DOI:10.1177/10742484211069422

PMID:35006026

Abstract

AIM

This retrospective cohort study aimed to evaluate the prognostic implications of the distinct atrial fibrillation (AF) temporal patterns: first diagnosed, paroxysmal, and persistent or permanent AF.

METHODS

In this post hoc analysis of the MISOAC-AF trial (NCT02941978), a total of 1052 patients with AF (median age 76 years), discharged from the cardiology ward between 2015 and 2018, were analyzed. Kaplan-Meier and Cox-regression analyses were performed to compare the primary outcome of all-cause mortality, the secondary outcomes of stroke, major bleeding and the composite outcome of cardiovascular (CV) mortality or hospitalization among AF patterns.

RESULTS

Of patients, 121 (11.2%) had first diagnosed, 356 (33%) paroxysmal, and 575 (53.2%) persistent or permanent AF. During a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients died. Compared with paroxysmal AF, patients with persistent or permanent AF had higher mortality rates (adjusted hazard ratio (aHR), 1.37; 95% confidence interval [CI], 1.08-1.74, = .009), but similar CV mortality or hospitalization rates (aHR, 1.09; 95% CI, 0.91-1.31, = .35). Compared with first diagnosed AF, patients with persistent or permanent AF had similar mortality (aHR, 1.26; 95% CI, 0.87-1.82, = .24), but higher CV mortality or hospitalization rates (aHR, 1.35; 95% CI, 1.01-1.8, = .04). Stroke and major bleeding events did not differ across AF patterns (all > .05).

CONCLUSIONS

In conclusion, in recently hospitalized patients with comorbid AF, the presence of persistent or permanent AF was associated with a higher incidence of mortality and morbidity compared with paroxysmal and first diagnosed AF.

摘要

目的

本回顾性队列研究旨在评估不同心房颤动（AF）时间模式的预后意义：首次诊断、阵发性、持续性或永久性 AF。

方法

在 MISOAC-AF 试验（NCT02941978）的事后分析中，共分析了 2015 年至 2018 年期间从心脏病病房出院的 1052 例 AF 患者（中位年龄 76 岁）。进行 Kaplan-Meier 和 Cox 回归分析，以比较 AF 模式之间的全因死亡率这一主要结局、卒中、大出血的次要结局以及心血管（CV）死亡率或住院的复合结局。

结果

在患者中，121 例（11.2%）为首次诊断、356 例（33%）为阵发性、575 例（53.2%）为持续性或永久性 AF。在中位随访 31 个月（四分位距 10 至 52 个月）期间，37.3%的患者死亡。与阵发性 AF 相比，持续性或永久性 AF 患者的死亡率更高（调整后的危险比（aHR），1.37；95%置信区间 [CI]，1.08-1.74， =.009），但 CV 死亡率或住院率相似（aHR，1.09；95% CI，0.91-1.31， =.35）。与首次诊断的 AF 相比，持续性或永久性 AF 患者的死亡率相似（aHR，1.26；95% CI，0.87-1.82， =.24），但 CV 死亡率或住院率更高（aHR，1.35；95% CI，1.01-1.8， =.04）。AF 模式之间的卒中发生率和大出血事件无差异（均 >.05）。