Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2022 May;31(5):638-646. doi: 10.1016/j.hlc.2021.12.013. Epub 2022 Feb 4.
Approximately 5-10% of patients presenting for percutaneous coronary intervention (PCI) have concurrent atrial fibrillation (AF). To what extent AF portends adverse long-term outcomes in these patients remains to be defined.
We analysed data from the multicentre Melbourne Interventional Group Registry from 2014-2018. Patients were identified as being in AF or sinus rhythm (SR) at the commencement of PCI. The primary endpoint was long-term mortality, obtained via linkage with the National Death Index.
13,286 procedures were included, with 800 (6.0%) patients in AF and 12,486 (94.0%) in SR. Compared to SR, patients with AF were older (72.9±10.9 vs 64.1±12.0 p<0.001) and more likely to have comorbidities including diabetes mellitus (31.3% vs 25.0% p<0.001), hypertension (74.4% vs 65.1% p<0.001) and moderate to severe left ventricular systolic dysfunction (36.6% vs 19.5% p<0.001). Atrial fibrillation was associated with an increased risk of in-hospital mortality (11.0% vs 2.5% p<0.001) and MACE (composite of all-cause mortality, myocardial infarction, or target vessel revascularisation) (11.9% vs 4.2% p<0.001). In-hospital major bleeding was more common in the AF group (3.1% vs 1.0% p<0.001). On Cox proportional hazards modelling, AF was an independent predictor of long-term mortality (adjusted HR 1.38 95% CI 1.11-1.72 p<0.004) at a mean follow-up of 2.3±1.5 years.
Preprocedural AF is common among patients presenting for PCI. Preprocedural AF is associated with high-rates of comorbid illnesses and portends higher risk of short- and long-term outcomes including mortality underscoring the need for careful evaluation of its risks prior to PCI.
约 5-10%行经皮冠状动脉介入治疗（PCI）的患者同时患有心房颤动（AF）。AF 对这些患者的长期预后有何影响仍有待确定。
我们分析了 2014-2018 年多中心墨尔本介入组注册中心的数据。患者在接受 PCI 时被确定为 AF 或窦性节律（SR）。主要终点是通过与国家死亡指数链接获得的长期死亡率。
共纳入 13286 例患者，其中 800 例（6.0%）患者为 AF，12486 例（94.0%）为 SR。与 SR 相比，AF 患者年龄更大（72.9±10.9 岁 vs 64.1±12.0 岁，p<0.001），合并症更多，包括糖尿病（31.3% vs 25.0%，p<0.001）、高血压（74.4% vs 65.1%，p<0.001）和中度至重度左心室收缩功能障碍（36.6% vs 19.5%，p<0.001）。AF 与住院期间死亡率（11.0% vs 2.5%，p<0.001）和主要不良心血管事件（MACE，全因死亡率、心肌梗死或靶血管血运重建的复合终点）（11.9% vs 4.2%，p<0.001）的风险增加相关。AF 组住院期间大出血更常见（3.1% vs 1.0%，p<0.001）。在 Cox 比例风险模型中，AF 是长期死亡率的独立预测因素（调整后的 HR 1.38，95%CI 1.11-1.72，p<0.004），平均随访时间为 2.3±1.5 年。
在接受 PCI 的患者中，术前 AF 很常见。术前 AF 与较高的合并症发生率相关，并预示着短期和长期结局（包括死亡率）的风险更高，这突显了在 PCI 前仔细评估其风险的必要性。
