Yu Shenglong, Li Chenxi, Guo Huizhuang
Department of Cardiovascular, Panyu Central Hospital, Guangzhou, China.
Medical Department, Queen Mary School, Nanchang University, Nanchang, China.
Front Cardiovasc Med. 2022 Nov 3;9:1046298. doi: 10.3389/fcvm.2022.1046298. eCollection 2022.
To evaluate the advantages and disadvantages of anticoagulant therapy and provide a piece of information on anti-thrombotic treatment strategies for patients with new-onset atrial fibrillation (NOAF) and acute myocardial infarction (AMI).
Literature from PubMed and Google scholar were screened until August 2022. Studies assessing oral anticoagulant (OAC) treatments for NOAF in patients with AMI were evaluated for inclusion.
Three retrospective cohort studies were included. In the study performed by Madsen et al., patients with previously diagnosed AMI with or without NOAF were followed up for 5.8 years. About 38% of NOAF patients with anticoagulant therapies, which could reduce long-term mortality [adjusted hazard ratio (HR): 0.69; 95% confidence interval (CI): 0.47-1.00]. Hofer et al. performed a single-center cohort study containing 1,372 patients with AMI with an 8.6-year follow-up period. Dual anti-thrombotic therapy (DAT) did not show the effect on the survival in NOAF (adjusted HR: 0.97; 95% CI: 0.65-1.57), while triple antithrombotic therapy (TAT) could reduce long-term cardiovascular mortality (adjusted HR: 0.86; 95% CI: 0.45-0.92). Petersen et al. also did a cohort study with 1-year follow-up duration. It showed that anticoagulant therapies demonstrated positive results (HR: 0.78; 95% CI: 0.41-1.47).
Recent studies have shown that anticoagulant therapy in AMI-NOAF patients can obviously reduce the mortality of AMI-NOAF patients, especially OAC therapy. Further clinical trials could confirm these findings.
评估抗凝治疗的优缺点，并为新发房颤（NOAF）和急性心肌梗死（AMI）患者提供抗栓治疗策略的相关信息。
筛选截至2022年8月来自PubMed和谷歌学术的文献。评估关于AMI患者中NOAF的口服抗凝剂（OAC）治疗的研究以纳入分析。
纳入三项回顾性队列研究。在Madsen等人进行的研究中，对先前诊断为AMI且伴有或不伴有NOAF的患者进行了5.8年的随访。约38%接受抗凝治疗的NOAF患者，这可降低长期死亡率[调整后风险比（HR）：0.69；95%置信区间（CI）：0.47 - 1.00]。Hofer等人进行了一项单中心队列研究，包含1372例AMI患者，随访期为8.6年。双联抗栓治疗（DAT）对NOAF患者的生存未显示出效果（调整后HR：0.97；95%CI：0.65 - 1.57），而三联抗栓治疗（TAT）可降低长期心血管死亡率（调整后HR：0.86；95%CI：0.45 - 0.92）。Petersen等人也进行了一项随访期为1年的队列研究。结果显示抗凝治疗显示出阳性结果（HR：0.78；95%CI：0.41 - 1.47）。
近期研究表明，AMI - NOAF患者的抗凝治疗可显著降低AMI - NOAF患者的死亡率，尤其是OAC治疗。进一步的临床试验可证实这些发现。
