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首页> 外文期刊>The American Journal of Cardiology >Effects of Atrial Fibrillation and Chronic Kidney Disease on Major Adverse Cardiovascular Events
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Effects of Atrial Fibrillation and Chronic Kidney Disease on Major Adverse Cardiovascular Events

机译：心房颤动和慢性肾病对主要不良心血管事件的影响

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Atrial fibrillation (AF) is strongly linked to chronic kidney disease (CKD) and both of these conditions contribute to poor cardiovascular outcomes. We evaluated the impact of renal failure on major adverse cardiovascular events (MACE) in AF, and predictive value of the 2MACE score in this post-hoc analysis of the AMADEUS trial. The primary endpoint was MACE (composite of myocardial infarction, cardiac revascularisation and cardiovascular mortality). Secondary endpoints included the composite of stroke, major bleeding and non-cardiovascular mortality, and each of the specific outcomes separately. Of the 4,554 patients, 1,526 (33.5%) were females and the median age was 71 (IQR 64 to 77) years. There were 3,838 (84.3%) non-CKD and 716 (15.7%) CKD patients. The incidence of cardiovascular and non-cardiovascular mortality were 1.41% and 2.44% per 100 patient-years, respectively. There was no significant difference in crude study endpoints between the groups. Multivariable regression analysis found no association between CKD and MACE (HR 1.03 [95% CI, 0.45 to 2.34]). The c-index of the 2MACE score for MACE was 0.65 (95% CI, 0.59 to 0.71, p <0.001). In the presence of CKD, each additional point of the 2MACE score contributed to a greater risk of MACE (HR 3.17 [95% CI, 1.28 to 7.85] vs 1.48 [95% CI, 1.17 to 1.87] in the non-CKD group). In conclusion, the 2MACE score may be a useful tool for clinical risk stratification of high-risk AF patients with CKD and those at high MACE risk could be targeted for more intensive cardiovascular prevention strategies. The presence of CKD was not found to be independently associated with MACE in AF patients. (C) 2020 Elsevier Inc. All rights reserved.
机译：心房颤动（AF）与慢性肾病（CKD）密切相关，这两种疾病都会导致心血管疾病的不良后果。在AMADEUS试验的事后分析中，我们评估了肾功能衰竭对房颤主要不良心血管事件（MACE）的影响，以及2MACE评分的预测价值。主要终点是MACE（心肌梗死、心脏血运重建和心血管死亡率的综合指标）。次要终点包括卒中、大出血和非心血管疾病死亡率的综合指标，以及单独的每个具体结果。4554名患者中，1526名（33.5%）为女性，中位年龄为71岁（IQR 64至77岁）。非CKD患者3838例（84.3%），CKD患者716例（15.7%）。心血管和非心血管死亡率的发生率分别为每100患者年1.41%和2.44%。两组之间的原始研究终点没有显著差异。多变量回归分析发现CKD和MACE之间没有相关性（HR1.03[95%CI，0.45至2.34]）。MACE评分的c指数为0.65（95%CI，0.59至0.71，p<0.001）。在有CKD的情况下，2MACE评分的每增加一分都会增加MACE的风险（非CKD组的HR3.17[95%CI，1.28至7.85]与1.48[95%CI，1.17至1.87]）。总之，2MACE评分对于伴有CKD的高危房颤患者的临床风险分层可能是一个有用的工具，而那些MACE风险高的患者可以作为更强化心血管预防策略的目标。未发现CKD的存在与房颤患者的MACE独立相关。（C） 2020爱思唯尔公司版权所有。

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