Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
University of Ottawa, Ottawa, Ontario, Canada.
Open Heart. 2022 Sep;9(2). doi: 10.1136/openhrt-2022-002012.
Atrial fibrillation (AF) remains a highly prevalent arrhythmia with significant burden on morbidity and mortality. The impact of AF in the revascularised population remains incompletely described. Given the high prevalence of AF in the revascularised population, we sought to evaluate the incidence and prognosis in patients with pre-existing and new-onset AF following revascularisation.
We used the University of Ottawa Heart Institute Revascularisation Registry to identify patients who underwent revascularisation between August 2015 and March 2020, who were prospectively followed for an average of one year. We conducted a retrospective cohort study analysing the association between AF and clinical outcomes. The primary outcome of interest was 1-year major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, unplanned revascularisation and cerebrovascular accidents. Moreover, secondary outcomes include the individual components of MACE and bleeding.
A total of 6704 patients underwent revascularisation and completed 1-year clinical follow-up. Median time to follow-up was 12.8 (IQR 11.2-15.9) months. One-year MACE occurred in 166 (21.8%) and 683 (11.5%) patients in AF and non-AF groups, respectively (adjusted HR, 1.61; 95% CI 1.29 to 2.01; p<0.0001). AF was independently predictive of 1-year mortality, myocardial infarction, unplanned revascularisation, cerebrovascular accident and bleeding. Within 1 year, 299 (4.5%) episodes of new-onset AF was observed. New-onset AF following revascularisation was also associated with 1-year MACE, mortality, myocardial infarction, cerebrovascular accident and unplanned revascularisation.
Preprocedural and new-onset AF following revascularisation remains highly predictive 1-year MACE. AF should be considered in addition to traditional risk factors for adverse outcomes following revascularisation.
心房颤动（AF）仍然是一种发病率很高的心律失常，对发病率和死亡率有重大影响。AF 在血运重建人群中的影响仍未完全描述。鉴于 AF 在血运重建人群中的高患病率，我们试图评估血运重建后患者预先存在和新发 AF 的发生率和预后。
我们使用渥太华大学心脏研究所血运重建登记处来识别 2015 年 8 月至 2020 年 3 月期间接受血运重建的患者，并对其进行平均为期一年的前瞻性随访。我们进行了一项回顾性队列研究，分析 AF 与临床结局之间的关系。主要研究终点为 1 年主要不良心脏事件（MACE），定义为死亡、心肌梗死、非计划性血运重建和脑血管意外的复合终点。此外，次要结局包括 MACE 和出血的各个组成部分。
共有 6704 例患者接受血运重建并完成 1 年临床随访。中位随访时间为 12.8（IQR 11.2-15.9）个月。AF 组和非-AF 组分别有 166（21.8%）和 683（11.5%）例患者在 1 年内发生 MACE（调整后的 HR，1.61；95%CI，1.29 至 2.01；p<0.0001）。AF 独立预测 1 年死亡率、心肌梗死、非计划性血运重建、脑血管意外和出血。在 1 年内，观察到 299 例（4.5%）新发 AF 发作。血运重建后新发 AF 也与 1 年 MACE、死亡率、心肌梗死、脑血管意外和非计划性血运重建相关。
血运重建前和血运重建后新发 AF 仍然高度预测 1 年 MACE。AF 应在血运重建后不良结局的传统危险因素之外考虑。
