来自 K-ACTIVE 注册研究的急性心肌梗死患者中房颤的影响及其临床结局。
Impact of atrial fibrillation and the clinical outcomes in patients with acute myocardial infarction from the K-ACTIVE registry.
机构信息
Department of Internal Medicine, Division of Cardiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-8501, Japan.
Department of Cardiovascular Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan.
出版信息
J Cardiol. 2022 Jun;79(6):768-775. doi: 10.1016/j.jjcc.2022.02.007. Epub 2022 Feb 23.
BACKGROUND
The clinical incidence and impact of atrial fibrillation (AF) in Japanese acute myocardial infarction (AMI) patients is not fully understood.
METHODS
To elucidate the clinical incidence and impact of AF on in-hospital mortality in AMI patients, we analyzed a Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry), which spans 2015 to 2019. A major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. For assessing bleeding events, Bleeding Academic Research Consortium (BARC) type 3 or 5 was used. MACE plus BARC type 3 or 5 bleeding were considered as composite events. The clinical outcomes were followed for 1 year.
RESULTS
The total of 5059 patients included 531 patients with AF (10.5%) and 4528 patients with sinus rhythm (SR; 89.5%). AF patients were significantly older and tended to have more comorbidities than SR patients. Oral anticoagulation therapy (OAC) was used in 44% of AF patients while single antiplatelet therapy was selected for 52% of patients with OAC. Crude in-hospital mortality was significantly greater in AF patients than in SR patients (10.4%, 5.0%, respectively, p < 0.01). The multivariate analysis was adjusted for age, sex, diabetes, hypertension, hemodialysis, smoking, previous MI, body mass index, Killip classification, out of hospital cardiac arrest, and OAC. In-hospital mortality was still significantly greater in AF patients than in SR patients in the logistic regression analysis [adjusted odds ratio 2.02 (1.31-3.14)]. AF was an independent risk factor for MACE and composite events in the Cox proportional hazards model [adjusted risk ratio (ARR) 1.91 (1.36-2.69), p < 0.01; ARR 1.72 (1.25-2.36), p < 0.01]. In contrast, AF was not an independent risk factor for bleeding [ARR 1.71 (0.79-3.71), p = 0.18].
CONCLUSION
In Japanese AMI patients, AF was often observed and was associated with worse MACE but not worse bleeding.
背景
心房颤动（AF）在日本急性心肌梗死（AMI）患者中的临床发生率和影响尚不完全清楚。
方法
为了阐明 AF 对 AMI 患者住院死亡率的临床发生率和影响，我们分析了一项日本观察性前瞻性多中心急性心肌梗死注册研究（K-ACTIVE：神奈川急性心血管注册研究），该研究时间跨度为 2015 年至 2019 年。主要不良心脏事件（MACE）定义为心血管死亡、非致命性心肌梗死（MI）和非致命性卒中。为评估出血事件，使用了 Bleeding Academic Research Consortium（BARC）3 型或 5 型。将 MACE 加 BARC 3 型或 5 型出血定义为复合事件。临床结果随访 1 年。
结果
共纳入 5059 例患者，其中 531 例患者（10.5%）患有 AF，4528 例患者（89.5%）为窦性心律（SR）。AF 患者明显较 SR 患者年龄更大，且合并症更多。44%的 AF 患者接受了口服抗凝治疗（OAC），而 52%的 OAC 患者选择了单一抗血小板治疗。AF 患者的住院死亡率明显高于 SR 患者（分别为 10.4%和 5.0%，p<0.01）。多变量分析调整了年龄、性别、糖尿病、高血压、血液透析、吸烟、既往 MI、体重指数、Killip 分级、院外心脏骤停和 OAC。在 logistic 回归分析中，AF 患者的住院死亡率仍明显高于 SR 患者[校正比值比（OR）2.02（1.31-3.14）]。在 Cox 比例风险模型中，AF 是 MACE 和复合事件的独立危险因素[校正风险比（ARR）1.91（1.36-2.69），p<0.01；ARR 1.72（1.25-2.36），p<0.01]。相反，AF 不是出血的独立危险因素[ARR 1.71（0.79-3.71），p=0.18]。
结论
在日本 AMI 患者中，AF 较为常见，与更差的 MACE 相关，但与更差的出血无关。
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