背景:急性冠脉综合征(ACS)常伴有新诊断的心房颤动(AF)。
目的:我们旨在比较ACS患者的主要不良心血管事件(MACE)风险,新诊断,或者没有AF。
方法:在我们的多中心,前瞻性注册研究,我们纳入了确诊的ACS患者.患者被分类为已知,新诊断或无房颤。新诊断的房颤根据发作的持续时间进行细分。发病时间,冠状动脉旁路移植术(CABG)后或自发发生,和口服抗凝剂(OAC)治疗。主要终点是1年的MACE。关键次要终点包括缺血性卒中和出血并发症。
结果:在4,433例确诊的ACS患者中,3,598(81.2%)没有房颤,438(9.9%)新诊断为房颤,397(9.0%)已知房颤。新诊断AF患者出院时OAC治疗率为53.4%,已知AF患者出院时OAC治疗率为89.2%。调整基线不平衡后,只有新的房颤与MACE发生率的增加独立相关,而已知房颤没有(风险比[HR]1.52,95%置信区间[CI]:1.19-1.90和HR0.93,95%CI:0.70-1.23).对于新诊断为房颤的ACS患者,与<24小时的发作相比,持续>24小时的发作与更高的MACE风险相关(HR1.99,95%CI:1.36~2.93).与自发发生的新AF相比,CABG后发生的新AF发作具有更有利的结果(MACE的HR0.52,95%CI:0.31-0.86)。在新的房颤亚类中,OAC治疗率较高,MACE和缺血性卒中发生率较高。
结论:与无房颤或已知房颤的ACS患者相比,ACS患者新诊断的房颤与更高的MACE和缺血性卒中发生率相关。在患有新房颤的ACS患者中,持续>24小时的发作与较短的发作相比,结果更差,而与自发性房颤相比,CABG后房颤的发生结果相对较好。只有53%的新房颤患者接受OAC治疗后出院,而已知房颤患者为89%。
BACKGROUND: Acute coronary syndrome (ACS) is frequently accompanied by newly diagnosed atrial fibrillation (AF).
OBJECTIVE: We aimed to compare the risk of major adverse cardiovascular events (MACE) in ACS patients presenting with known, newly diagnosed, or no AF.
METHODS: In our multicentre, prospective registry study, we included patients with confirmed ACS. Patients are classified as having known, newly diagnosed or no AF. Newly diagnosed AF is subdivided according to the duration of the episode, time of onset, post-coronary artery bypass graft (CABG) or spontaneous occurrence, and treatment with oral anticoagulants (OAC). The primary endpoint is MACE at 1 year. Key secondary endpoints include ischaemic stroke and bleeding complications.
RESULTS: Amongst 4,433 patients with confirmed ACS, 3,598 (81.2%) had no AF, 438 (9.9%) had newly diagnosed AF, and 397 (9.0%) had known AF. The rates of OAC treatment at discharge were 53.4% in patients with newly diagnosed AF and 89.2% in patients with known AF. After adjusting for baseline imbalances, only new AF was independently associated with increased rates of MACE, whereas known AF was not (hazard ratio [HR] 1.52, 95% confidence interval [CI]: 1.19-1.90 and HR 0.93, 95% CI: 0.70-1.23). For ACS patients with newly diagnosed AF, episodes lasting >24 hours were associated with a higher risk of MACE compared to episodes <24 hours (HR 1.99, 95% CI: 1.36-2.93). Episodes of new AF occurring post-CABG had more favourable outcomes compared to spontaneously occurring new AF (HR for MACE 0.52, 95% CI: 0.31-0.86). OAC treatment rates were higher in the new AF subcategories with higher rates of MACE and ischaemic stroke.
CONCLUSIONS: Newly diagnosed AF in ACS patients was associated with higher rates of MACE and ischaemic stroke compared to ACS patients without or with known AF. Among the ACS patients with new AF, an episode lasting >24 hours was associated with worse outcomes than shorter episodes, while post-CABG occurrence of AF showed relatively better outcomes compared to spontaneously occurring AF. Only 53% of new AF patients were discharged on OAC therapy versus 89% with known AF.