Atrial fibrillation and death after myocardial infarction: a community study.
Atrial fibrillation and death after myocardial infarction: a community study.
复制标题
DOI：
10.1161/circulationaha.110.990192
复制
发表时间：
2011-05-17
期刊：
影响因子：
37.8
通讯作者：
Roger VL
中科院分区：
文献类型：
--
作者：
Jabre P;Jouven X;Adnet F;Thabut G;Bielinski SJ;Weston SA;Roger VL
心房颤动（AF）常与心肌梗死（MI）共存，但其对预后的影响尚存争议。先前的报告研究了急性心肌梗死早期住院期间房颤对死亡风险的作用，但无法解决与心肌梗死相关的房颤时间（即之前、期间和之后）。此外，由于数据主要来自临床试验，它们对社区的适用性是不确定的。本研究的目的是评估心梗患者发生房颤的情况，确定其是否随时间发生变化，并量化其影响及其发生时间对心梗后死亡率的影响。本研究是一项基于社区的队列研究，研究对象为明尼苏达州奥姆斯特德县1983年至2007年间3220例住院的突发（首次）心梗患者。通过诊断代码和心电图诊断房颤。结果为全因死亡和心血管死亡。304例患者在心肌梗死前发现房颤，729例患者在心肌梗死后发生房颤（218例（30%）在2天内，119例（16%）在3 - 30天内，392例（54%）在心肌梗死后30天内）。心肌梗死后5年AF的累积发病率为19%，在心肌梗死的历年期间没有变化。在平均6.6年的随访期间，发生了1638例死亡。房颤与死亡风险增加相关(HR (95% CI) 3.77(3.37-4.21))，与心肌梗死和心力衰竭时的临床特征无关。根据房颤发生时间的不同，这种风险有显著差异，在心肌梗死后30天内发生房颤的风险最大(HR (95% CI): 2天内房颤1.63(1.37-1.93)，3 - 30天房颤1.81(0.45 - 2.27)，心肌梗死后30天房颤>(2.58(2.21-3.00))。在社区中，房颤常见于心肌梗死。房颤具有额外的死亡风险，在心肌梗死后30天以上发生房颤的风险最高。
Atrial fibrillation (AF) often coexists with myocardial infarction (MI), yet its prognostic influence is controversial. Prior reports studied the role of AF during the early hospitalization for acute MI on the risk of death and could not address the timing of AF in relation to the MI (i.e. prior, during, post). Further, as data come mostly from clinical trials, their applicability to the community is uncertain. The aims of our study were to assess the occurrence of AF among MI patients, determine whether it has changed over time, and quantify its impact and the impact of its timing on mortality after MI. This was a community-based cohort of 3220 patients hospitalized with incident (first-ever) MI from 1983 to 2007 in Olmsted County, Minnesota. AF was identified by diagnostic codes and ECG. Outcomes were all-cause and cardiovascular death. AF prior to MI was identified in 304 patients and 729 developed AF after MI (218 (30%) within 2 days, 119 (16%) between 3 and 30 days, and 392 (54%) >30 days post-MI). The cumulative incidence of AF after MI at 5 years was 19% and did not change over calendar year of MI. During a mean follow-up of 6.6 years, 1638 deaths occurred. AF was associated with an increased risk of death (HR (95% CI) 3.77 (3.37–4.21)), independently of clinical characteristics at the time of MI and heart failure. This risk differed markedly according to the timing of AF and was the greatest for AF occurring >30 days post-MI (HR (95% CI) 1.63 (1.37–1.93) for AF within 2 days, 1.81 (.45–2.27) for AF between 3 and 30 days, and 2.58 (2.21–3.00) for AF > 30 days post MI). In the community, AF is frequent in the setting of MI. AF carries an excess risk of death, which is the highest for AF developing more than 30 days post-MI.