Wang Jing-Yang, Mo Ran, Zhu Jun, Tan Jiang-Shan, Wang Lu-Lu, Xu Wei, Wang Juan, Wu Shuang, Lyu Si-Qi, Zhang Han, Yang Yan-Min
Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Heliyon. 2024 Jul 25;10(15):e35218. doi: 10.1016/j.heliyon.2024.e35218. eCollection 2024 Aug 15.
Restoring and maintaining sinus rhythm in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has been studied in clinical trials to reduce symptoms and improve quality of life. Limited data exist on the effectiveness of rate or rhythm control therapy in these patients.
Consecutive patients with AF and ACS or referred for PCI were prospectively recruited in Fuwai Hospital during 2017-2020. The primary endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, non-central nervous system embolism and ischemia-driven revascularization. Kaplan-Meier curves and Cox regressions were performed to evaluate the association between rhythm/rate control and subsequent outcomes. For the primary endpoints, we used the Benjamini-Hochberg correction for multiple comparisons.
A total of 1499 patients with AF and ACS or undergoing PCI were included, with a median follow-up of 34.7 months. Compared to non-rate control, rate control strategy reduced the risk of subsequent MACCEs (adjusted HR, 0.320; 95 % CI 0.220-0.466; p <0.001; *p <0.002) and all-cause death (adjusted HR, 0.148; 95 % CI 0.093-0.236; p <0.001; *p <0.002). Similar trends were observed across all predefined subgroups (p <0.001). In the final multivariate model, rhythm control was not associated with a lower subsequent MACCEs but significantly improved all-cause mortality compared to non-rhythm control (adjusted HR, 0.546; 95 % CI 0.313-0.951; p =0.033; *p =0.044).
In this real-world study, rate control strategy was associated with lower risk of MACCEs and all-cause death in AF and ACS or undergoing PCI. Besides, management with rhythm control strategy may improve all-cause mortality.
在临床试验中，已对恢复和维持心房颤动（AF）合并急性冠状动脉综合征（ACS）患者或接受经皮冠状动脉介入治疗（PCI）患者的窦性心律进行了研究，以减轻症状并改善生活质量。关于这些患者心率或节律控制治疗的有效性的数据有限。
2017年至2020年期间，在北京阜外医院前瞻性招募了连续的AF合并ACS患者或因PCI就诊的患者。主要终点是全因死亡和主要不良心血管和脑血管事件（MACCE），包括心血管死亡、心肌梗死、缺血性中风、非中枢神经系统栓塞和缺血驱动的血运重建。采用Kaplan-Meier曲线和Cox回归分析来评估节律/心率控制与后续结局之间的关联。对于主要终点，我们使用Benjamini-Hochberg校正进行多重比较。
共纳入1499例AF合并ACS患者或接受PCI的患者，中位随访时间为34.7个月。与非心率控制相比，心率控制策略降低了后续MACCE的风险（校正后HR，0.320；95%CI 0.220-0.466；p<0.001；*p<0.002）和全因死亡风险（校正后HR，0.148；95%CI 0.093-0.236；p<0.001；*p<0.002）。在所有预先定义的亚组中均观察到类似趋势（p<0.001）。在最终的多变量模型中，与非节律控制相比，节律控制与较低的后续MACCE无关，但显著改善了全因死亡率（校正后HR，0.546；95%CI 0.313-0.951；p=0.033；*p=0.044）。
在这项真实世界研究中，心率控制策略与AF合并ACS患者或接受PCI患者较低的MACCE风险和全因死亡风险相关。此外，采用节律控制策略进行管理可能会改善全因死亡率。
