新发心房颤动的急性冠脉综合征患者的结局。

Outcomes of newly diagnosed atrial fibrillation in patients with acute coronary syndromes.

机构信息

St. Antonius Hospital, Nieuwegein, the Netherlands.

Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

出版信息

EuroIntervention. 2024 Aug 19;20(16):996-1007. doi: 10.4244/EIJ-D-23-01049.

DOI:10.4244/EIJ-D-23-01049

PMID:39155759

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11317829/

Abstract

BACKGROUND

Acute coronary syndrome (ACS) is frequently accompanied by newly diagnosed atrial fibrillation (AF).

AIMS

We aimed to compare the risk of major adverse cardiovascular events (MACE) in ACS patients presenting with known, newly diagnosed, or no AF.

METHODS

In our multicentre, prospective registry study, we included patients with confirmed ACS. Patients are classified as having known, newly diagnosed or no AF. Newly diagnosed AF is subdivided according to the duration of the episode, time of onset, post-coronary artery bypass graft (CABG) or spontaneous occurrence, and treatment with oral anticoagulants (OAC). The primary endpoint is MACE at 1 year. Key secondary endpoints include ischaemic stroke and bleeding complications.

RESULTS

Amongst 4,433 patients with confirmed ACS, 3,598 (81.2%) had no AF, 438 (9.9%) had newly diagnosed AF, and 397 (9.0%) had known AF. The rates of OAC treatment at discharge were 53.4% in patients with newly diagnosed AF and 89.2% in patients with known AF. After adjusting for baseline imbalances, only new AF was independently associated with increased rates of MACE, whereas known AF was not (hazard ratio [HR] 1.52, 95% confidence interval [CI]: 1.19-1.90 and HR 0.93, 95% CI: 0.70-1.23). For ACS patients with newly diagnosed AF, episodes lasting >24 hours were associated with a higher risk of MACE compared to episodes <24 hours (HR 1.99, 95% CI: 1.36-2.93). Episodes of new AF occurring post-CABG had more favourable outcomes compared to spontaneously occurring new AF (HR for MACE 0.52, 95% CI: 0.31-0.86). OAC treatment rates were higher in the new AF subcategories with higher rates of MACE and ischaemic stroke.

CONCLUSIONS

Newly diagnosed AF in ACS patients was associated with higher rates of MACE and ischaemic stroke compared to ACS patients without or with known AF. Among the ACS patients with new AF, an episode lasting >24 hours was associated with worse outcomes than shorter episodes, while post-CABG occurrence of AF showed relatively better outcomes compared to spontaneously occurring AF. Only 53% of new AF patients were discharged on OAC therapy versus 89% with known AF.

摘要

背景

急性冠状动脉综合征（ACS）常伴有新发的心房颤动（AF）。

目的

我们旨在比较伴有已知、新发或无 AF 的 ACS 患者发生主要不良心血管事件（MACE）的风险。

方法

在我们的多中心前瞻性注册研究中，我们纳入了确诊为 ACS 的患者。将患者分为已知、新发或无 AF。新发 AF 根据发作持续时间、发病时间、冠状动脉旁路移植术（CABG）后或自发性发生以及是否使用口服抗凝剂（OAC）进行亚组分类。主要终点是 1 年时的 MACE。关键次要终点包括缺血性卒中和出血并发症。

结果

在 4433 例确诊为 ACS 的患者中，3598 例（81.2%）无 AF，438 例（9.9%）有新发 AF，397 例（9.0%）有已知 AF。新发 AF 患者出院时 OAC 治疗率为 53.4%，已知 AF 患者为 89.2%。在调整基线失衡后，只有新发 AF 与 MACE 发生率增加独立相关，而已知 AF 则不然（风险比[HR] 1.52，95%置信区间[CI]：1.19-1.90 和 HR 0.93，95% CI：0.70-1.23）。对于 ACS 伴新发 AF 的患者，与持续时间＜24 小时的患者相比，持续时间＞24 小时的患者发生 MACE 的风险更高（HR 1.99，95% CI：1.36-2.93）。与自发性新发 AF 相比，CABG 后发生的新发 AF 具有更好的结局（MACE 风险 HR 0.52，95% CI：0.31-0.86）。新发 AF 亚组的 MACE 和缺血性卒中等事件发生率较高，OAC 治疗率也较高。

结论

与无 AF 或已知 AF 的 ACS 患者相比，ACS 患者新发 AF 与更高的 MACE 和缺血性卒中等事件发生率相关。在 ACS 伴新发 AF 的患者中，与持续时间较短的患者相比，持续时间＞24 小时的患者结局较差，而 CABG 后发生的 AF 与自发性发生的 AF 相比，结局相对较好。仅有 53%的新发 AF 患者出院时接受 OAC 治疗，而已知 AF 患者为 89%。