New atrial fibrillation after acute myocardial infarction independently predicts death: The GUSTO-III experience
New atrial fibrillation after acute myocardial infarction independently predicts death: The GUSTO-III experience
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DOI：
10.1067/mhj.2000.111108
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发表时间：
2000-12-01
影响因子：
4.8
通讯作者：
Ohman, EM
中科院分区：
文献类型：
--
作者：
Wong, CK;White, HD;Ohman, EM
背景 心肌梗死后发生的心房颤动（AF）或扑动可能单独发生或与其他并发症相关。心律失常是否预示着独立于当代治疗的其他并发症的不良预后尚不清楚。方法和结果作为全球使用开通闭塞冠状动脉策略[GUSTO-III)试验的一部分，我们评估了梗死后并发症是否与随后发生房颤相关，以及房颤是否独立预测30天和1年内的死亡。收集的信息包括 30 天内死亡和主要院内梗死后并发症的确切时间。在 13,858 名入组时患有窦性心律的患者中，906 名后来出现房颤或心房扑动，12,952 名则没有。我们比较了这两组之间的结果，调整了基线特征和纤颤前并发症的差异。心力衰竭恶化、低血压、三度心脏传导阻滞和心室颤动是新发房颤的独立预测因素。患有 AF 的患者与未患有 AF 的患者相比，未经调整的死亡比值比 (OR) 为 2.74（95% 置信区间 [95% CI]，2.56-3.34）。调整基线差异后，OR 降低至 1.63（95% CI，1.31-2.02）。在 AF 发病前对其他院内并发症进行调整，进一步将 OR 降低至 1.49（95% CI，1.17-1.89）。结论 心房颤动或扑动继发于其他梗塞后并发症，但独立预示着较差的预后。预防和管理可以改善结果。
Background Atrial fibrillation (AF) or flutter occurring after myocardial infarction may occur alone or in association with other complications. Whether the arrhythmia portends a poor prognosis independent of other complications with contemporary therapy is unknown.Methods and Results As port of the Global Use of Strategies To Open occluded coronary arteries [GUSTO-III) trial, we evaluated whether postinfarction complications were associated with the subsequent development of AF and whether AF independently predicted death over periods of 30 days and 1 year. Information including exact timing was collected on deaths and major in-hospital postinfarction complications up to 30 days. Of the 13,858 patients with sinus rhythm at enrollment, 906 later had AF or flutter and 12,952 did not. We compared outcomes between these 2 groups, adjusting for differences in baseline characteristics and prefibrillation complications. Worsening heart failure, hypotension, third-degree heart block, and ventricular fibrillation were independent predictors of new-onset AF. The unadjusted odds ratio (OR) for death among patients with versus those without AF was 2.74 (95% confidence interval [95% CI], 2.56-3.34). After adjusting For baseline differences, the OR was reduced to 1.63 (95% CI, 1.31-2.02). Adjustment for other in-hospital complications before the onset of AF further reduced the OR to 1.49 (95% CI, 1.17-1.89).Conclusions Atrial fibrillation or flutter occurs secondary to other postinfarction complications but independently portends a worse prognosis. Prevention and management may improve outcome.