Division of Minimally Invasive Treatment in Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
Saiseikai Toyama Hospital, Toyama, Japan.
Cardiovasc Interv Ther. 2024 Apr;39(2):145-155. doi: 10.1007/s12928-024-00984-9. Epub 2024 Feb 13.
Real-world data on coronary events (CE) in elderly patients with atrial fibrillation (AF) are lacking in the direct oral anticoagulant era. This prespecified sub-analysis of the ANAFIE Registry, a prospective observational study in > 30,000 Japanese patients aged ≥ 75 years with non-valvular AF (NVAF), investigated CE incidence and risk factors. The incidence and risk factors for new-onset CE (a composite of myocardial infarction [MI] and cardiac intervention for coronary heart diseases other than MI), MI, and cardiac intervention for coronary heart diseases other than MI during the 2-year follow-up were assessed. Bleeding events in CE patients were also examined. Among 32,275 patients, the incidence rate per 100 patient-years was 0.48 (95% confidence interval (CI): 0.42-0.53) for CE during the 2-year follow-up, 0.20 (0.16-0.23) for MI, and 0.29 (0.25-0.33) for cardiac intervention for coronary heart diseases other than MI; that of stroke/systemic embolism was 1.62 (1.52-1.73). Patients with CE (n = 287) likely had lower creatinine clearance (CrCL) and higher CHADS and HAS-BLED scores than patients without CE (n = 31,988). Significant risk factors associated with new-onset CE were male sex, systolic blood pressure of ≥ 130 mmHg, diabetes mellitus (glycated hemoglobin ≥ 6.0%), CE history, antiplatelet agent use, and CrCL < 50 mL/min. Major bleeding incidence was significantly higher in patients with new-onset CE vs without CE (odds ratio [95% CI], 3.35 [2.06-5.43]). In elderly patients with NVAF, CE incidence was lower than stroke/systemic embolism incidence. New-onset CE (vs no CE) was associated with a higher incidence of major bleeding.Trial registration: UMIN000024006.
在直接口服抗凝剂时代，缺乏老年房颤（AF）患者冠状动脉事件（CE）的真实世界数据。该研究是 ANAFIE 注册研究的一项预设亚分析，这是一项针对 > 30000 名年龄 ≥ 75 岁的日本非瓣膜性房颤（NVAF）患者的前瞻性观察性研究，旨在调查 CE 发生率和危险因素。评估了 2 年随访期间新发 CE（心肌梗死 [MI] 和 MI 以外的冠心病心脏介入的复合终点）、MI 和 MI 以外的冠心病心脏介入的发生率和危险因素。还检查了 CE 患者的出血事件。在 32275 名患者中，2 年随访期间每 100 名患者年的 CE 发生率为 0.48（95%置信区间：0.42-0.53），MI 发生率为 0.20（0.16-0.23），MI 以外的冠心病心脏介入发生率为 0.29（0.25-0.33）；卒中/全身性栓塞发生率为 1.62（1.52-1.73）。与无 CE 患者（n=31988）相比，CE 患者（n=287）的肌酐清除率（CrCL）可能较低，CHADS 和 HAS-BLED 评分较高。与新发 CE 相关的显著危险因素包括男性、收缩压 ≥ 130mmHg、糖尿病（糖化血红蛋白 ≥ 6.0%）、CE 病史、抗血小板药物使用和 CrCL < 50mL/min。与无新发 CE 患者相比，新发 CE 患者的主要出血发生率显著较高（比值比[95%置信区间]，3.35[2.06-5.43]）。在老年 NVAF 患者中，CE 发生率低于卒中/全身性栓塞发生率。与无 CE 患者相比，新发 CE（无 CE）与更高的主要出血发生率相关。试验注册：UMIN000024006。
