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首页> 美国卫生研究院文献>Clinical Cardiology >Mortality and rate of stroke or embolism in atrial fibrillation during long‐term follow‐up in the embolism in left atrial thrombi (ELAT) study
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Mortality and rate of stroke or embolism in atrial fibrillation during long‐term follow‐up in the embolism in left atrial thrombi (ELAT) study

机译：长期研究中左心房血栓栓塞症的长期随访期间心房纤颤的卒中死亡率和发生率

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Background: Patients with atrial fibrillation (AF) have a higher mortality and risk of stroke/embolism than patients with sinus rhythm. Hypothesis: The aim of the study was to assess the association of clinical and echocardiographic characteristics with mortality and stroke/embolism and the use of antithrombotic medicationin the year 2000 in patients who participated 1990‐1995 in the Embolism in Left Atrial Thrombi (ELAT) study. Methods: The study included 409 outpatients with non‐rheumatic AF (62 ± 12 years, 36% women, 39% intermittent AF). Patients with thrombi received anticoagulation, patients without thrombi aspirin until follow‐up in 1995; thereafter, anticoagulation according to clinical risk factors was recommended. Primary events were death and secondary events were stroke/embolism. All patients were contacted during the year 2000. Results: Mean follow‐up was 102 months. Mortality was 4%/year; the cause of death was cardiac (n=84), fatal stroke (n = 26), malignancy (n = 23), sepsis (n = 5), and unknown (n = 24). Multivariate analysis identified age (p < 0.0001), heart failure (p = 0.0013), and reduced left ventricular systolic function (p = 0.0353) as predictors of mortality. Stroke/embolism occurred in 83 patients, with a rate of 3%/year. Multivariate analysis identified age (p = 0.0006) and previous stroke (p = 0.0454) as predictors of stroke/embolism. In the year 2000, 51 (21%) of the 247 surviving patients received no antithrombotic medication, 88 received (36%) oral anticoagulants, 102 (41%) acetylsalicylic acid, and 6 (2%) low‐molecular heparin. Conclusions: Therapy for heart failure and oral anticoagulation in AF should be seriously considered, especially in elderly patients and in those with previous stroke.
机译：背景：与窦性心律患者相比，房颤（AF）患者的死亡率和中风/栓塞风险更高。假设：该研究的目的是评估参加1990-1995年左心房血栓栓塞（ELAT）研究的患者在2000年的临床和超声心动图特征与死亡率和中风/栓塞的关系以及抗栓药物的使用。方法：该研究纳入了409例非风湿性AF门诊患者（62±12岁，女性为36％，间歇性AF为39％）。有血栓形成的患者接受抗凝治疗，没有血栓形成阿司匹林的患者接受抗凝治疗，直到1995年随访。此后，建议根据临床危险因素进行抗凝治疗。主要事件是死亡，次要事件是中风/栓塞。在2000年期间与所有患者进行了接触。结果：平均随访时间为102个月。死亡率为4％/年；死亡原因为心脏（n = 84），致命性中风（n = 26），恶性肿瘤（n = 23），败血症（n = 5）和未知（n = 24）。多变量分析确定了年龄（p <0.0001），心力衰竭（p = 0.0013）和左心室收缩功能降低（p = 0.0353）作为死亡率的预测指标。中风/栓塞发生在83例患者中，发生率为3％/年。多变量分析将年龄（p = 0.0006）和先前的卒中（p = 0.0454）确定为卒中/栓塞的预测指标。在2000年，幸存的247名患者中有51名（21％）未接受抗栓药物，88名（36％）口服抗凝药，102名（41％）乙酰水杨酸和6名（2％）低分子肝素。结论：应认真考虑房颤的心力衰竭和口服抗凝治疗，特别是对于老年患者和中风患者。

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