Division of Cardiology, Novant Health Heart & Vascular Institute, Charlotte, NC, USA.
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.
Cardiovasc Revasc Med. 2022 Nov;44:37-43. doi: 10.1016/j.carrev.2022.06.258. Epub 2022 Jun 28.
We aimed to determine whether newly diagnosed atrial fibrillation (AF) predicted cardiovascular events and death after myocardial infarction (AMI) in a large nationwide cohort of patients. All Medicare beneficiaries aged >65 years who were discharged alive after a diagnosis of AMI between January 1, 2007 and December 31, 2008 were identified. Main exposure was a diagnosis of AF during admission or within 90 days after discharge. Primary outcome was a composite of recurrent AMI, stroke and all-cause mortality. Secondary outcomes were each of recurrent AMI, stroke and all-cause mortality. We used Cox proportional hazards regression to assess the relationship between AF and time-to-event outcomes with follow up ending at 3 years. Of 184,980 patients, 9.1 % had AF; 40.6 % were male; 82.8 % were non-Hispanic whites. Mean age was 79.1 ± 8.1 years. Overall, 15.7 % had subsequent AMI, 5.7 % had stroke and 43.9 % died during a mean follow up of 26.4 months. AF was associated with a significantly increased risk of the primary outcome (Hazard ratio (HR) = 1.10; 95 % confidence interval (CI): 1.07-1.12). AF was also separately associated with significantly increased risk of recurrent AMI (HR = 1.09; 95 % CI: 1.04-1.14), stroke (HR = 1.29; 95 % CI: 1.21-1.37), and death (HR = 1.09; 95 % CI: 1.06-1.12). Neither age, race nor sex modified the effects of AF on primary or secondary outcomes. In conclusion, AF is a significant predictor of adverse cardiovascular outcomes and mortality after AMI. Further studies are needed to understand mechanisms by which AF alters outcomes in survivors of AMI.
我们旨在确定在一个大型全国性患者队列中，新发心房颤动（AF）是否可预测心肌梗死（AMI）后的心血管事件和死亡。确定了所有在 2007 年 1 月 1 日至 2008 年 12 月 31 日期间被诊断为 AMI 后存活出院的年龄>65 岁的 Medicare 受助人。主要暴露是入院期间或出院后 90 天内诊断为 AF。主要结果是复发性 AMI、中风和全因死亡率的复合结果。次要结果是复发性 AMI、中风和全因死亡率的各个结果。我们使用 Cox 比例风险回归来评估 AF 与时间相关的事件结果之间的关系，随访截止至 3 年。在 184980 名患者中，9.1%患有 AF；40.6%为男性；82.8%为非西班牙裔白人。平均年龄为 79.1±8.1 岁。总体而言，15.7%发生了后续 AMI，5.7%发生了中风，43.9%在平均 26.4 个月的随访期间死亡。AF 与主要结果的风险显著增加相关（危险比（HR）=1.10；95%置信区间（CI）：1.07-1.12）。AF 还与复发性 AMI（HR=1.09；95%CI：1.04-1.14）、中风（HR=1.29；95%CI：1.21-1.37）和死亡（HR=1.09；95%CI：1.06-1.12）的风险显著增加相关。年龄、种族或性别均未改变 AF 对主要或次要结果的影响。总之，AF 是 AMI 后不良心血管结局和死亡率的重要预测指标。需要进一步研究以了解 AF 如何改变 AMI 幸存者的结局的机制。
