背景:钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)对房颤(AF)消融术后心力衰竭(HF)患者的房颤复发和不良心血管结局的影响尚不清楚。
目的:探讨SGLT2i是否能降低HF患者房颤消融术后房颤复发和不良心血管结局的风险。
方法:纳入中国AF注册中心在2017年1月至2022年12月期间接受导管消融术的房颤患者。根据出院时使用SGLT2i将患者分为2组,并通过倾向评分进行1:1匹配,在每组中使用SGLT2i(n=368)和非SGLT2i(n=368)。主要结果是3个月消隐期后房颤复发。
结果:在总共1315人年的随访中,SGLT2i组83例(22.6%)和非SGLT2i组132例(35.8%)房颤复发。SGLT2i与房颤复发风险较低相关(校正后HR=0.56,95%CI:0.43-0.74,P<0.001)。心血管死亡的复合风险,血栓形成事件,与没有SGLT2i的患者相比,SGLT2i组的心血管住院率显著降低(校正后的HR=0.58,95CI:0.41-0.80,p=0.001).虽然有好处的趋势,全因死亡率的差异,心血管死亡,或血栓性事件在两组之间不显著.
结论:SGLT2i的使用与较低的房颤复发风险和心血管死亡的复合结局相关。血栓形成事件,HF患者导管消融术后或心血管住院。
BACKGROUND: The impact of sodium-glucose cotransporter 2 inhibitors (
SGLT2i) on atrial fibrillation (AF) recurrence outcomes and adverse cardiovascular outcomes in heart failure (HF) patients after AF ablation is unknown.
OBJECTIVE: To investigate whether SGLT2i reduces the risk of AF recurrence and adverse cardiovascular outcomes in HF patients after AF ablation.
METHODS: HF patients with AF undergoing catheter ablation between January 2017 and December 2022 from the China-AF Registry were included. Patients were stratified into 2 groups based on the use of
SGLT2i at discharge and were 1:1 matched by propensity score, with
SGLT2i using (n=368) and non-
SGLT2i using (n=368) in each group. The primary outcome was AF recurrence after a 3-month blanking period.
RESULTS: During a total of 1315 person-year follow-ups, AF recurrence occurred in 83 patients (22.6%) in the SGLT2i group and 132 patients (35.8%) in the non-
SGLT2i group. SGLT2i was associated with a lower risk of AF recurrence (adjusted HR = 0.56, 95% CI: 0.43-0.74, P<0.001). The composite risk of cardiovascular death, thrombotic events, or cardiovascular hospitalization was significantly lower in the SGLT2i group compared with those without
SGLT2i (adjusted HR = 0.58, 95%CI: 0.41-0.80, p = 0.001). Although there was a trend toward benefits, the differences in all-cause mortality, cardiovascular death, or thrombotic events were insignificant between the 2 groups.
CONCLUSIONS: The use of SGLT2i was associated with a lower risk of AF recurrence and the composite outcome of cardiovascular death, thrombotic events, or cardiovascular hospitalization after catheter ablation for AF in patients with HF.