Gouda Pishoy, Dover Douglas C, Savu Anamaria, Bainey Kevin, Goodman Shaun G, Welsh Robert, Kaul Padma, Sandhu Roopinder Kaur
Division of Cardiology, University of Alberta, Edmonton, Canada.
Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.
Am J Cardiol. 2022 Mar 15;167:54-61. doi: 10.1016/j.amjcard.2021.11.043. Epub 2022 Jan 7.
Short-term outcomes are worse for patients with acute coronary syndrome (ACS) with a history of nonvalvular atrial fibrillation (NVAF). However, long-term prognosis remains unclear. We linked administrative health databases to identify patients hospitalized with ACS (ST-elevation myocardial infarction [STEMI], non-STEMI [NSTEMI], and unstable angina) between 2008 and 2019 in Alberta, Canada. Patients were stratified according to history of NVAF before hospitalization. The primary outcome was a composite of all-cause mortality, hospitalization for myocardial infarction, or stroke at 3 years. Cox models were constructed to estimate the association between ACS, NVAF, and outcomes. Of 54,309 ACS hospitalizations, 6,351 patients (11.7%) had a history of NVAF. Compared with patients without NVAF, patients with previous NVAF were older (75.6 ± 11.6 vs 64.9 ± 13.4 years), women (35.1% vs 30.0%), had higher comorbid burden (Charlson co-morbidity index 3.0 vs 1.0), and more often presented with NSTEMI (57.5% vs 49.0%). The primary outcome occurred in 37.0% of patients with previous NVAF and 17.4% without (p <0.001). In the multivariable analysis, there was a 1.14-fold (95% confidence interval [CI] 1.09 to 1.20) higher risk of the primary outcome in patients with previous NVAF. There was a significant association with STEMI (adjusted harazard ratio [aHR] 1.24, 95% CI 1.12 to 1.36) and NSTEMI (aHR 1.12, 95% CI 1.06 to 1.19) but not with unstable angina (aHR 1.04, 95% CI 0.90 to 1.22). In conclusion, in this population-based study, we identified that a history of NVAF at ACS presentation is associated with worse long-term prognosis, particularly for STEMI and NSTEMI.
对于有非瓣膜性心房颤动（NVAF）病史的急性冠状动脉综合征（ACS）患者，其短期预后较差。然而，长期预后仍不明确。我们将行政健康数据库相链接，以识别2008年至2019年期间在加拿大艾伯塔省因ACS（ST段抬高型心肌梗死[STEMI]、非ST段抬高型心肌梗死[NSTEMI]和不稳定型心绞痛）住院的患者。根据住院前NVAF病史对患者进行分层。主要结局是3年时全因死亡率、心肌梗死住院或卒中的复合结局。构建Cox模型以估计ACS、NVAF与结局之间的关联。在54309例ACS住院患者中，6351例患者（11.7%）有NVAF病史。与无NVAF的患者相比，既往有NVAF的患者年龄更大（75.6±11.6岁对64.9±13.4岁），女性比例更高（35.1%对30.0%），合并症负担更重（Charlson合并症指数3.0对1.0），且更常表现为NSTEMI（57.5%对49.0%）。主要结局发生在37.0%的既往有NVAF的患者中以及17.4%的无NVAF的患者中（p<0.001）。在多变量分析中，既往有NVAF的患者发生主要结局的风险高1.14倍（95%置信区间[CI]1.09至1.20）。与STEMI（调整后风险比[aHR]1.24，95%CI 1.12至1.36）和NSTEMI（aHR 1.12，95%CI 1.06至1.19）存在显著关联，但与不稳定型心绞痛无关（aHR 1.04，95%CI 0.90至1.22）。总之，在这项基于人群的研究中，我们发现ACS发病时的NVAF病史与更差的长期预后相关，尤其是对于STEMI和NSTEMI。
