Blum Steffen, Aeschbacher Stefanie, Coslovsky Michael, Meyre Pascal B, Reddiess Philipp, Ammann Peter, Erne Paul, Moschovitis Giorgio, Di Valentino Marcello, Shah Dipen, Schläpfer Jürg, Müller Rahel, Beer Jürg H, Kobza Richard, Bonati Leo H, Moutzouri Elisavet, Rodondi Nicolas, Meyer-Zürn Christine, Kühne Michael, Sticherling Christian, Osswald Stefan, Conen David
Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.
Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
Sci Rep. 2022 Feb 9;12(1):2208. doi: 10.1038/s41598-022-05688-9.
Sustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was a composite of stroke or systemic embolism (SE). Secondary outcomes included myocardial infarction, hospitalization for congestive heart failure (CHF), bleeding and all-cause mortality. Multivariable adjusted Cox proportional hazards models with time-varying covariates were used to compare hazard ratios (HR) according to AF type. At baseline 1895 (49%), 1046 (27%) and 902 (24%) patients had paroxysmal, persistent and permanent AF and 3234 (84%) were anticoagulated. After a median (IQR) follow-up of 3.0 (1.9; 4.2) years, the incidence of stroke/SE was 1.0 per 100 patient-years. The incidence of myocardial infarction, CHF, bleeding and all-cause mortality was 0.7, 3.0, 2.9 and 2.7 per 100 patient-years, respectively. The multivariable adjusted (a) HRs (95% confidence interval) for stroke/SE were 1.13 (0.69; 1.85) and 1.27 (0.83; 1.95) for time-updated persistent and permanent AF, respectively. The corresponding aHRs were 1.23 (0.89, 1.69) and 1.45 (1.12; 1.87) for all-cause mortality, 1.34 (1.00; 1.80) and 1.30 (1.01; 1.67) for CHF, 0.91 (0.48; 1.72) and 0.95 (0.56; 1.59) for myocardial infarction, and 0.89 (0.70; 1.14) and 1.00 (0.81; 1.24) for bleeding. In this large prospective cohort of AF patients, time-updated AF type was not associated with incident stroke/SE.
持续性房颤（AF）可能与更高的不良结局风险相关，但几乎没有长期研究考虑到房颤类型和合并症随时间的变化。我们对3843例房颤患者进行了前瞻性随访，并在每年的随访中收集了房颤类型和合并症的信息。主要结局是卒中或系统性栓塞（SE）的复合终点。次要结局包括心肌梗死、充血性心力衰竭（CHF）住院、出血和全因死亡率。使用具有时间变化协变量的多变量调整Cox比例风险模型，根据房颤类型比较风险比（HR）。基线时，1895例（49%）、1046例（27%）和902例（24%）患者分别患有阵发性、持续性和永久性房颤，3234例（84%）接受了抗凝治疗。在中位（IQR）随访3.0（1.9；4.2）年后，卒中/SE的发生率为每100患者年1.0例。心肌梗死、CHF、出血和全因死亡率的发生率分别为每100患者年0.7例、3.0例、2.9例和2.7例。卒中/SE的多变量调整（a）HR（95%置信区间），时间更新的持续性和永久性房颤分别为1.13（0.69；1.85）和1.27（0.83；1.95）。全因死亡率的相应aHR分别为1.23（0.89，1.69）和1.45（1.12；1.87），CHF为1.34（1.00；1.80）和1.30（1.01；1.67），心肌梗死为0.91（0.48；1.72）和0.95（0.56；1.59），出血为0.89（0.70；1.14）和1.00（0.81；1.24）。在这个大型房颤患者前瞻性队列中，时间更新的房颤类型与卒中/SE的发生无关。
