冠心病合并心房颤动患者的治疗及临床结局分析  

Analysis of treatment and clinical outcome of patients with coronary heart disease and atrial fibrillation

作　　者：董敏 邹彤 何清华 徐蕾 李雨薇 汪芳 杨杰孚 DONG Min;ZOU Tong;HE Qing-hua;XU Lei;LI Yu-wei;WANG Fang;YANG Jie-fu(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Endocrinology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]国家老年医学中心,中国医学科学院老年医学研究院,北京医院心内科,北京市100730 [2]国家老年医学中心,中国医学科学院老年医学研究院,北京医院内分泌科,北京市100730 [3]国家老年医学中心,中国医学科学院老年医学研究院,北京医院神经内科,北京市100730

出　　处：《中国心血管病研究》2021年第3期208-213,共6页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(81570307);首都卫生发展科研专项(重点)(首发2016-1-4051)。

摘　　要：目的分析冠心病合并心房颤动(房颤)患者的治疗现状和其随访期间发生的主要不良心脑血管事件(MACCE)及影响因素。方法本研究为回顾性队列研究。连续入组2013年1月至2015年3月期间本院收治的冠心病合并房颤患者共343例,收集患者临床资料。出院后通过电话、门诊及住院病例查询等方式随访至少5年,记录其MACCE。根据临床结局将患者分为MACCE组和非MACCE组,通过单因素和多因素分析得出冠心病合并房颤患者远期发生MACCE的独立危险因素。结果共有332例患者纳入研究,中位生存时间77.0个月(53.7,60.3)个月。平均患病种类(6.4±1.9)种,最常见的合并症有高血压(83.7%)、高脂血症(60.5%)、慢性心力衰竭(50.0%)、糖尿病(38.9%)和慢性肾脏病(35.2%)。随访中,298例(89.8%)发生MACCE,152例(45.8%)死亡,MACCE的年标化率为18.7/100人年。随着MACCE发生次数的增加,死亡比例随之升高。多因素回归分析显示,用药种类(OR=1.33,95%CI 1.21~1.57)、冠状动脉三支病变(OR=2.45,95%CI 1.01~5.95)、D-二聚体≥0.124 mg/L(OR=4.04,95%CI 1.77~9.22)和左心房内径≥45 mm(OR=2.99,95%CI 1.17~7.62)是冠心病合并房颤患者远期发生MACCE的独立危险因素。结论冠心病合并房颤患者合并症多,远期预后差。多重用药、冠状动脉三支病变、D二聚体升高和左心房增大提示远期发生MACCE风险高。Objective To analyze the treatment status,the main adverse cardiovascular and cerebrovascular events(MACCE)and its influencing factors in patients with coronary heart disease and atrial fibrillation(AF).Methods A total of 343 patients with coronary heart disease and atrial fibrillation were enrolled from January 2013 to March 2015.After discharge,the patients were followed up for at least 5 years by telephone,outpatient and inpatient case inquiry and MACCE were recorded.They were divided into MACCE group and non MACCE group according to the clinical outcome.The independent risk factors of MACCE in patients with coronary heart disease and atrial fibrillation were obtained by univariate and multivariate analysis.Results A total of 332 patients were included in the study,with a median survival time of 77.0(53.7,60.3)months.The most common complications were hypertension(83.7%),hyperlipidemia(60.5%),chronic heart failure(50.0%),diabetes mellitus(38.9%)and chronic kidney disease(35.2%).During the follow-up,298 cases(89.8%)developed MACCE and 152 cases(45.8%)died.The annual standardized rate of MACCE was 18.7/100 person year.With the increase of MACCE,the death increased.Multivariate regression analysis showed that the types of medication(OR=1.33,95%CI 1.21-1.57),three vessel disease(OR=2.45,95%CI 1.01-5.95),D-dimer≥0.124 mg/L(OR=4.04,95%CI 1.77-9.22)and left atrial diameter≥45 mm(OR=2.99,95%CI 1.17-7.62)were independent risk factors for long-term MACCE in patients with coronary heart disease and atrial fibrillation.Conclusion Patients with coronary heart disease and atrial fibrillation have more comorbidities,thus their long-term prognosis is poor.Polypharmacy,three vessel disease,D-dimer elevation and left atrial enlargement suggest a high risk of MACCE in the long term.

关 键 词：冠状动脉疾病 心房颤动 死亡 主要不良心脑血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]