Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction
Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction
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DOI：
10.1093/eurheartj/ehi629
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发表时间：
2006-02-01
影响因子：
39.3
通讯作者：
Torp-Pedersen, C
中科院分区：
文献类型：
--
作者：
Pedersen, OD;Abildstrom, SZ;Torp-Pedersen, C
目的心房颤动(房颤)是急性心肌梗死患者的常见并发症，与死亡风险增加有关。房颤合并急性心肌梗死的超额死亡率尚未得到详细研究。观察表明，房颤容易诱发室性心律失常，这可能会增加心血管猝死(SCD)的风险。对死亡模式的仔细检查可能会为指导进一步的研究和治疗提供有用的知识。方法和结果我们分析了5983名在Trandolapril心脏评估登记中筛选的急性心肌梗死后存活出院的患者的房颤/心房扑动(AFL)与死亡模式的关系。在1990-92年间，27个中心收治了这群经酶检测确诊的急性心肌梗死患者。最后一名患者筛查2年后获得生存状态。一个独立的终点委员会评估了死亡方式。所有筛查的患者都测定了左心室射血分数，并前瞻性地收集了有关是否存在房颤/房颤的信息。1149例(19%)患者在住院期间观察到持续性或阵发性房颤/房颤。在随访期间，1659名患者(34%)死亡：482名(50%)房颤/房颤患者和1177名(30%)非房颤/房颤患者，P<；0.001。发生SCD 536例，非SCD 725例，非心血管原因死亡398例(其中不明原因142例)。房颤/急性淋巴细胞性白血病对总死亡率的调整风险比为1.33(95%CI：1.19-1.49；P<；0.0001)，对SCD的调整风险比为1.31(95%CI：1.0 7-1.6；P<；0.009)。0.0001)。结论急性心肌梗死后房颤/房颤患者的高死亡率是由于心源性心脏病和非心源性心脏病的显著增加所致。
Aims Atrial fibrillation (AF) is a common complication in patients with acute myocardial infarction and is associated with an increase in the risk of death. The excess mortality associated with AF complicating acute myocardial infarction has not been studied in detail. Observations indicate that AF facilitates induction of ventricular arrhythmias, which may increase the risk of sudden cardiovascular death (SCD). A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments.Methods and results We analysed the relation between AF/atrial flutter (AFL) and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infarction screened in the TRAndolapril Cardiac Evaluation registry. This cohort of patients with an enzyme-verified acute myocardial infarction was admitted to 27 centres in 1990-92. Survival status was obtained 2 years after screening of the last patient. An independent endpoint committee assessed the modes of death. Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospectively collected. Sustained or paroxysmal AF/AFL was observed in 1149 patients (19%) during hospitalization. During follow-up, 1659 patients (34%) died: 482 (50%) patients with AF/AFL and 1177 (30%) patients without AF/AFL, P < 0.001. SCD occurred in 536, non-SCD occurred in 725, and 398 died of non-cardiovascular causes (includes 142 unclassifiable cases). The adjusted risk ratio of AF/AFL for total mortality was 1.33 (95% CI: 1.19-1.49; P < 0.0001) and the risk ratio for SCD was 1.31 (95% CI: 1.07-1.60; P < 0.009).The adjusted risk ratio of AF/AFL for non-SCD was 1.43 (95% CI: 1.21-1.70; P < 0.0001).Conclusion The excess mortality observed in patients with AF/AFL following acute myocardial infarction is due to a significant increase in both SCD and non-SCD.