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首页> 外文期刊>The American Journal of Cardiology >Antithrombotic Strategies and Outcomes in Acute Coronary Syndrome With Atrial Fibrillation
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Antithrombotic Strategies and Outcomes in Acute Coronary Syndrome With Atrial Fibrillation

机译:心房纤颤急性冠脉综合征的抗血栓形成策略和结果

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摘要

Atrial fibrillation (AF) frequently occurs with acute coronary syndromes (ACS) and adds complexity to the selection of an appropriate antithrombotic strategy. We determined whether associations of antithrombotic treatment with bleeding, stroke, and death differ between patients with ACS with and without AF. Residents of Olmsted County, Minnesota, hospitalized with incident ACS during 2005 to 2010 were classified according to the presence or absence of AF either before or during the index ACS hospitalization. Antithrombotic strategy at discharge was categorized as double/triple agents versus no/single agent. Patients were followed through 2012, and propensity scores were used to estimate associations of treatment with bleeding, ischemic stroke, and mortality. Of 1,159 patients with incident ACS, 252 (21.7%) had concomitant AF (ACS + AF). Over a median follow-up of 4.3 years, 312 bleeds, 67 ischemic strokes, and 268 deaths occurred. The overall risks of bleeding, stroke, and death were similar between treatment strategies. Although limited by the small number of events, a suggestion of a lower risk of ischemic stroke for patients with ACS + AF on double/triple therapy was observed; the hazard ratios for stroke with double/triple versus no/single therapy were 0.30 (0.07 to 1.26) and 1.10 (0.52 to 2.33) in those with and without AF, respectively (0 value for interaction = 0.10). In conclusion, the choice of antithrombotic strategy is not associated with the risk of ischemic stroke, bleeding, or death in patients with ACS overall. Patients with ACS + AF on double/triple therapy may experience reduced risks of stroke, although future studies are needed to confirm this finding. (C) 2015 Elsevier Inc. All rights reserved.
机译:心房颤动(AF)经常与急性冠状动脉综合征(ACS)一起发生,并增加了选择合适的抗血栓形成策略的复杂性。我们确定了有无AF的ACS患者之间抗栓治疗与出血,中风和死亡的相关性是否存在差异。明尼苏达州奥姆斯特德县(Olmsted County)的2005年至2010年因ACS住院的居民根据在ACS指数住院之前或期间是否存在房颤进行分类。出院时的抗血栓形成策略分为双重/三重药物与否/单一药物。对患者进行随访直至2012年,并使用倾向评分来估计治疗与出血,缺血性中风和死亡率的相关性。在1,159名发生ACS的患者中,有252名(21.7%)伴有AF(ACS + AF)。在4.3年的中位随访期中,发生了312例出血,67例缺血性中风和268例死亡。治疗策略之间的出血,中风和死亡的总体风险相似。尽管受事件数量的限制,但观察到双联/三联疗法对ACS + AF患者缺血性卒中的风险较低。在有AF和无AF的患者中,接受双重/三重疗法与否/单独/单一疗法的中风的危险比分别为0.30(0.07至1.26)和1.10(0.52至2.33)(交互作用0值= 0.10)。总之,抗栓策略的选择与ACS患者整体缺血性中风,出血或死亡的风险无关。 ACS + AF的双重/三联疗法患者可能会降低中风风险,尽管还需要进一步的研究来证实这一发现。 (C)2015 Elsevier Inc.保留所有权利。

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