Impact of atrial fibrillation and the clinical outcomes in patients with acute myocardial infarction from the K-ACTIVE registry
Impact of atrial fibrillation and the clinical outcomes in patients with acute myocardial infarction from the K-ACTIVE registry
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DOI：
10.1016/j.jjcc.2022.02.007
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发表时间：
2022-04-14
影响因子：
2.5
通讯作者：
Suzuki, Hiroshi
中科院分区：
文献类型：
--
作者：
Mori, Hiroyoshi;Fukui, Kazuki;Suzuki, Hiroshi
背景资料：日本急性心肌梗死（AMI）患者中房颤（AF）的临床发病率和影响尚不完全清楚。研究方法：为了阐明房颤的临床发病率和对AMI患者住院死亡率的影响，我们分析了2015年至2019年日本急性心肌梗死观察性前瞻性多中心登记研究（K ACTIVE：神奈川ACuTe cardIoVascular rEgistry）。主要心脏不良事件（MACE）定义为心血管死亡、非致死性心肌梗死（MI）和非致死性卒中。使用出血学术研究联盟（BARC）3型或5型评估出血事件。MACE + BARC 3型或5型出血被视为复合事件。随访1年。结果：5059例患者中，房颤患者531例（10.5%），窦性心律患者4528例（89.5%）。AF患者明显比SR患者年龄大，并且倾向于有更多的合并症。44%的AF患者使用口服抗凝治疗（OAC），而52%的OAC患者选择单一抗血小板治疗。AF患者的粗住院死亡率显著高于SR患者（分别为10.4%、5.0%，p < 0.01）。多变量分析校正了年龄、性别、糖尿病、高血压、血液透析、吸烟、既往MI、体重指数、Killip分级、院外心脏骤停和OAC。在logistic回归分析中，AF患者的院内死亡率仍显著高于SR患者[校正比值比2.02（1.31-3.14）]。在考克斯比例风险模型中，AF是MACE和复合事件的独立风险因素[校正风险比（ARR）1.91（1.36-2.69），p < 0.01; ARR 1.72（1.25-2.36），p < 0.01]。相反，AF不是出血的独立风险因素[ARR 1.71（0.79-3.71），p = 0.18]。结论：在日本AMI患者中，经常观察到AF，并与MACE恶化相关，但与出血恶化无关。(c)2022年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: The clinical incidence and impact of atrial fibrillation (AF) in Japanese acute myocardial infarction (AMI) patients is not fully understood. Methods: To elucidate the clinical incidence and impact of AF on in-hospital mortality in AMI patients, we analyzed a Japanese observational prospective multicenter registry of acute myocardial infarction (K ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry), which spans 2015 to 2019. A major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. For assessing bleeding events, Bleeding Academic Research Consortium (BARC) type 3 or 5 was used. MACE plus BARC type 3 or 5 bleeding were considered as composite events. The clinical outcomes were followed for 1 year. Results: The total of 5059 patients included 531 patients with AF (10.5%) and 4528 patients with sinus rhythm (SR; 89.5%). AF patients were significantly older and tended to have more comorbidities than SR patients. Oral anticoagulation therapy (OAC) was used in 44% of AF patients while single antiplatelet therapy was selected for 52% of patients with OAC. Crude in-hospital mortality was significantly greater in AF patients than in SR patients (10.4%, 5.0%, respectively, p < 0.01). The multivariate analysis was adjusted for age, sex, diabetes, hypertension, hemodialysis, smoking, previous MI, body mass index, Killip classification, out of hospital cardiac arrest, and OAC. In-hospital mortality was still significantly greater in AF patients than in SR patients in the logistic regression analysis [adjusted odds ratio 2.02 (1.31-3.14)]. AF was an independent risk factor for MACE and composite events in the Cox proportional hazards model [adjusted risk ratio (ARR) 1.91 (1.36-2.69), p < 0.01; ARR 1.72 (1.25-2.36), p < 0.01]. In contrast, AF was not an independent risk factor for bleeding [ARR 1.71 (0.79-3.71), p = 0.18]. Conclusion: In Japanese AMI patients, AF was often observed and was associated with worse MACE but not worse bleeding. (c) 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.