Department of Cardiology, The Seventh Affiliated Hospital of SunYat-sen University, Shenzhen, China.
Hanyi Data Technology (Shenzhen) Co., Ltd, Shenzhen, China.
BMC Cardiovasc Disord. 2024 Nov 27;24(1):684. doi: 10.1186/s12872-024-04349-1.
Current guidelines recommend maintaining a resting heart rate below 100-110 beats per minute (bpm) for patients with atrial fibrillation (AF). However, there is a lack of research on various treatment approaches for patients with both atrial fibrillation and coronary heart disease (AF&CHD). We have discussed the primary therapeutic options for controlling resting heart rate in patients with AF&CHD.
We conducted a post hoc analysis of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. Our study included 3986(98.2%) participants with AF, of which 1522 had AF&CHD. The primary outcome was all-cause mortality. We utilized the chi-squared test to identify significant differences in categorical variables. Multivariate Cox regression analysis was performed to compare the risk of death by standard deviation of heart rate visit to visit variability quartile.
Compared to the AF group, a higher proportion of patients in the AF&CHD group had histories of smoking, hypertension, diabetes, heart failure, cardiomyopathy, valvular heart disease, peripheral vascular disease, bradycardia, hepatic or renal disease, pulmonary disease, and stroke (all P < 0.001). Additionally, patients with AF&CHD were more likely to undergo coronary artery bypass grafting (CABG) and pacemaker surgeries than those with AF alone. After adjusting for multiple clinical variables, patients with AF&CHD had a significantly higher risk of all-cause mortality compared to the AF group (RR = 1.79, 95% CI: 1.49-2.60; P < 0.01). Nonlinear multivariate curve-fitting analysis identified an optimal resting heart rate of 70 bpm for patients with AF&CHD (P < 0.001). Subgroup analysis revealed that patients with a resting heart rate below 70 bpm had lower all-cause mortality than those with a resting heart rate above 70 bpm (P < 0.001).
For resting heart rates below 70 bpm, our results suggest an inverse causal relationship between genetically determined resting heart rate and all-cause mortality in patients with AF&CHD.
Not applicable.
目前的指南建议心房颤动（AF）患者的静息心率低于 100-110 次/分钟（bpm）。然而，对于同时患有心房颤动和冠心病（AF&CHD）的患者，各种治疗方法的研究还很缺乏。我们讨论了控制 AF&CHD 患者静息心率的主要治疗选择。
我们对 AFFIRM（心房颤动随访心律管理研究）试验进行了事后分析。我们的研究包括 3986 名（98.2%）患有 AF 的患者，其中 1522 名患有 AF&CHD。主要结局是全因死亡率。我们使用卡方检验来识别分类变量的显著差异。使用多变量 Cox 回归分析比较了心率就诊就诊变异性四分位距的标准偏差的死亡风险。
与 AF 组相比，AF&CHD 组有更高比例的患者有吸烟、高血压、糖尿病、心力衰竭、心肌病、瓣膜性心脏病、外周血管疾病、心动过缓、肝或肾功能障碍、肺部疾病和中风病史（均 P<0.001）。此外，与单纯 AF 患者相比，AF&CHD 患者更有可能接受冠状动脉旁路移植术（CABG）和起搏器手术。调整多个临床变量后，与 AF 组相比，AF&CHD 患者的全因死亡率显著更高（RR=1.79，95%CI：1.49-2.60；P<0.01）。非线性多变量曲线拟合分析确定了 AF&CHD 患者最佳静息心率为 70 bpm（P<0.001）。亚组分析显示，静息心率低于 70 bpm 的患者全因死亡率低于静息心率高于 70 bpm 的患者（P<0.001）。
对于静息心率低于 70 bpm 的患者，我们的结果表明，AF&CHD 患者的静息心率与全因死亡率之间存在遗传决定的反向因果关系。
不适用。
