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首页> 外文期刊>The American Journal of Cardiology >Prognostic Impact of Types of Atrial Fibrillation in Acute Coronary Syndromes
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Prognostic Impact of Types of Atrial Fibrillation in Acute Coronary Syndromes

机译：心房颤动类型对急性冠脉综合征的预后影响

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Atrial fibrillation (AF) has been established as an independent predictor of long-term mortality after acute myocardial infarction. However, this is less well defined across the whole spectrum of acute coronary syndromes (ACSs). The Acute Coronary Syndrome Prospective Audit is a prospective multicenter registry with 12-month outcome data for 3,393 patients (755 with ST-segment elevation myocardial infarction, 1942 with high-risk non-ST-segment elevation ACS [NSTE-ACS], and 696 with intermediate-risk NSTE-ACS). A total of 149 patients (4.4%) had new-onset AF and 387 (11.4%) had previous AF. New-onset AF was more, and previous AF was less frequent in those with ST-segment elevation myocardial infarction than in those with high-risk NSTE-ACS or intermediate-risk NSTE-ACS (p <0.001). Compared to patients without arrhythmia, patients with new-onset AF and previous AF were significantly older and had more high-risk features at presentation (p <0.004). Patients with new-onset AF more often had left main coronary artery disease, resulting in a greater rate of surgical revascularization (p <0.001). Only new-onset AF resulted in adverse in-hospital outcomes (p <0.001). Only patients with previous AF had greater long-term mortality (hazard ratio 1.42, p <0.05). New-onset AF was only associated with a worse long-term composite outcome (hazard ratio 1.66, p = 0.004). However, the odds ratio for the composite outcome was greatest for patients with new-onset AF with intermediate-risk NSTE-ACS (odds ratio 3.9, p = 0.02) than for those with high-risk NSTE-ACS (odds ratio 2.0, p = 0.01) or ST-segment elevation myocardial infarction (odds ratio 1.4, p=0.4). In conclusion, new-onset AF was associated with worse short-term outcomes and previous AF was associated with greater mortality even at long-term follow-up. The prognostic burden of new-onset AF differed with the type of ACS presentation. Crown Copyright.
机译：心房颤动（AF）已被确定为急性心肌梗死后长期死亡率的独立预测指标。但是，在急性冠脉综合征（ACS）的整个范围内，这一点的定义不太明确。急性冠状动脉综合征前瞻性审核是一项前瞻性多中心注册，提供3,393例患者的12个月结果数据（755例ST段抬高型心肌梗塞，1942年非ST段抬高高危ACS [NSTE-ACS]和696例）中等风险的NSTE-ACS）。共有149例患者（4.4％）患有新发房颤，而387例患者（11.4％）曾患有房颤。 ST段抬高型心肌梗死患者的新发房颤发生率更高，以前的房颤发生率低于高危NSTE-ACS或中危NSTE-ACS患者（p <0.001）。与没有心律不齐的患者相比，患有新发房颤和既往房颤的患者年龄明显偏大，并且呈现较高的高危特征（p <0.004）。患有新发房颤的患者更常患有左主冠状动脉疾病，从而导致手术血运重建率更高（p <0.001）。仅新发房颤会导致不良的院内预后（p <0.001）。只有先前患有房颤的患者具有更高的长期死亡率（危险比1.42，p <0.05）。新发房颤仅与较差的长期综合预后相关（危险比1.66，p = 0.004）。但是，新发房颤合并中危NSTE-ACS的患者的几率比最大（奇数比3.9，p = 0.02），而高危NSTE-ACS的患者（奇数比2.0，p） = 0.01）或ST段抬高型心肌梗死（赔率比1.4，p = 0.4）。总之，即使在长期随访中，新发房颤与较差的短期预后相关，既往房颤与较高的死亡率相关。新发房颤的预后负担因ACS表现的类型而异。皇冠版权。

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