Liporace Idelzuita Leandro, Oliveira Gustavo Bernardes F, Alves Lucas Bassolli de Oliveira, Galassi Nadia Marchiori, Jeronimo Andreia Dias, Lopes Fernanda Maria, Lip Gregory Y H, Avezum Álvaro
Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil.
Hospital Alemão Oswaldo Cruz, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2025 Jan;122(2):e20240147. doi: 10.36660/abc.20240147.
Vitamin K antagonists (VKA) represent an important therapeutic strategy offered by the Brazilian Unified Public Health System to patients with atrial fibrillation (AF). However, predictors of relevant clinical outcomes are understudied in the real world.
To determine the incidence and independent predictors of clinical outcomes in patients with valvular and nonvalvular AF treated with VKA.
This prospective cohort included patients with valvular and nonvalvular AF receiving VKA for ≥ 1 year. The primary outcomes were cardiovascular death, thromboembolic events, and major and clinically relevant non-major bleeding, separately and as a composite outcome. The outcomes were independently adjudicated. P values < 0.05 were considered statistically significant.
The study included 1,350 patients, with a mean age of 69.2 (± 11.8) years, 53.6% female, followed up for 17 (15 - 19) months. The annual incidence of thromboembolic events and cardiovascular death was 4.4%, and predictors were prior thromboembolism (hazard ratio [HR] 2.12; 95% confidence interval [CI] 1.22 - 3.67), time in therapeutic range (TTR) < 50% (HR 1.98; 95% CI 1.16 - 3.37), and glomerular filtration rate (GFR) < 45 mL/min/1.73 m2 (HR 2.76; 95% CI 4.82 - 1.58). The rate of major and clinically relevant non-major bleeding was 3.24% per year (95% CI 2.47 - 4.14), and predictors were prior bleeding (HR 2.60; 95% CI 1.47 - 4.61) and mechanical prosthesis (HR 1.91; 95% CI 1.15 - 3.15). The composite outcome was 8.7% per year, and predictors were prior bleeding (HR 1.70; 95% CI 1.07 - 2.70), TTR < 41% (HR 1.79; 95% CI 1.11 - 2.86), and left atrial diameter > 44 mm (HR 1.97; 95% CI 3.26 - 1.19).
Prior thromboembolism or bleeding, reduced GFR and TTR levels, and enlarged left atrium were predictors of clinical outcomes in patients with AF treated with VKA.
维生素K拮抗剂（VKA）是巴西统一公共卫生系统为心房颤动（AF）患者提供的一项重要治疗策略。然而，在现实世界中，相关临床结局的预测因素尚未得到充分研究。
确定接受VKA治疗的瓣膜性和非瓣膜性AF患者临床结局的发生率及独立预测因素。
这项前瞻性队列研究纳入了接受VKA治疗≥1年的瓣膜性和非瓣膜性AF患者。主要结局分别为心血管死亡、血栓栓塞事件、大出血和临床相关非大出血，以及复合结局。结局由独立判定。P值<0.05被认为具有统计学意义。
该研究纳入了1350例患者，平均年龄为69.2（±11.8）岁，女性占53.6%，随访时间为17（15 - ）个月。血栓栓塞事件和心血管死亡的年发生率为4.4%，预测因素为既往血栓栓塞（风险比[HR] 2.12；95%置信区间[CI] 1.22 - 3.67）、治疗范围内时间（TTR）<50%（HR 1.98；95% CI 1.16 - 3.37）以及肾小球滤过率（GFR）<45 mL/min/1.73 m2（HR 2.76；95% CI 4.82 - 1.58）。大出血和临床相关非大出血的发生率为每年3.24%（95% CI 2.47 - 4.14），预测因素为既往出血（HR 2.60；95% CI 1.47 - 4.61）和机械瓣膜（HR 1.91；95% CI 1.15 - 3.15）。复合结局的发生率为每年8.7%，预测因素为既往出血（HR 1.70；95% CI 1.07 - 2.70）、TTR<41%（HR 1.79；95% CI 1.11 - 2.86）以及左心房直径>44 mm（HR 1.97；95% CI 3.26 - 1.19）。
既往血栓栓塞或出血、GFR和TTR水平降低以及左心房增大是接受VKA治疗的AF患者临床结局的预测因素。
