Analysis of cause-specific mortality in the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study
Analysis of cause-specific mortality in the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study
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DOI：
10.1161/01.cir.0000118472.77237.fa
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发表时间：
2004-04-27
期刊：
影响因子：
37.8
通讯作者：
Greene, HL
中科院分区：
文献类型：
--
作者：
Steinberg, JS;Sadaniantz, A;Greene, HL
背景-房颤心律管理随访调查（AFFIRM）研究否定了房颤患者重建和维持窦性心律可能提高生存率的预期。本报告描述了死因的具体模式，在AFFIRM治疗groups.Methods和结果，所有死亡的AFFIRM事件委员会进行了盲法审查登记的患者，死亡的模式被分配。在AFFIRM中，2033例患者随机接受节律控制策略，2027例患者随机接受心率控制策略。在平均3.5年的随访中，心律控制组有356例死亡，心率控制组有310例死亡（P=0.07）。在节律控制组中，129例患者（9%）死于心脏原因，在心率控制组中，130例患者（10%）死亡（P=0.95）。两组的心肌梗死性和非心肌梗死性心源性死亡率相似。两组的血管性死亡数量相似：节律控制组35例（3%），心率控制组37例（3%）（P=0.82）。缺血性卒中和中枢神经系统出血的发生率无差异。在节律控制组中，有169例非心血管死亡（占死亡总数的47.5%），而在心率控制组中，有113例非心血管死亡（占死亡总数的36.5%）（P=0.0008）。非心血管死亡率的差异是由于肺和癌症相关的deaths. Conclusions管理房颤的节奏控制策略赋予心脏或血管死亡率的控制策略没有优势，并可能与增加非心血管死亡率。
Background-Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups.Methods and Results-All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths.Conclusions-Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.