心房颤动合并ACS住院患者抗凝治疗现状和其依从性及对1年预后的影响:一项多中心队列研究  

Anticoagulation status and adherence in patients with atrial fibrillation hospitalized for ACS and the impact on 1-year prognosis:a multicenter cohort study

作　　者：朱龙洋 李青 于璐瑶 刘颖 陈意浓 王喆[2] 张仕宇[3] 李静[4] 刘莹[5] 赵玉兰[6] 喜杨[7] 皮林[8] 孙艺红[3] Zhu Longyang;Li Qing;Yu Luyao;Liu Ying;Chen Yinong;Wang Zhe;Zhang Shiyu;Li Jing;Liu Ying;Zhao Yulan;Xi Yang;Pi Lin;Sun Yihong(Peking University Health Science Center,China-Japan Friendship Hospital,Beijing 100029,China;Department of Cardiology,China-Japan Friendship Hospital(Institute of Clinical Medical Sciences),Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100029,China;Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Cardiology,Capital Medical University,Xuanwu Hospital,Beijing 100053,China;Department of Cardiology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Cardiology,The Second Afiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Department of Hypertension,Peking University People's Hospital,Beijing 100044,China;Department of Cardiology,Chui Yang Liu Hospital Affiliated to Tsinghua University,Beijing 100021,China)

机构地区：[1]北京大学医学部中日友好临床医学院,北京100029 [2]中国医学科学院北京协和医学院中日友好医院(临床医学研究所)心脏科,北京100029 [3]中日友好医院心脏科,北京100029 [4]首都医科大学宣武医院老年科,北京100053 [5]大连医科大学第一医院心内科,大连116011 [6]郑州大学第二附属医院心内科,郑州450014 [7]北京大学人民医院高血压科,北京100044 [8]北京市垂杨柳医院心内科,北京100021

出　　处：《中华心血管病杂志》2023年第7期731-741,共11页Chinese Journal of Cardiology

基　　金：中日友好医院院级科研基金(2017-1-MS-2);首都卫生发展科研专项项目基金(2020-2-4065);北京市自然科学基金(7192189)。

摘　　要：目的:描述心房颤动(房颤)合并急性冠脉综合征(ACS)患者1年内抗栓治疗的现状和依从性以及抗凝治疗对1年预后的影响。方法:该研究为多中心回顾性队列研究,纳入2015年7月至2020年12月全国6家三级医院的房颤合并ACS住院患者。根据患者出院时抗栓治疗情况,分为抗凝治疗组和非抗凝治疗组。随访出院后1年的主要不良心血管事件(MACEs),包括全因死亡、非致死性心肌梗死或再次冠状动脉血运重建、缺血性卒中以及出血学术研究联合会(BARC)3型出血。采用logistic回归模型分析房颤合并ACS患者抗凝药物使用的影响因素。采用倾向得分匹配进行1∶1匹配,通过Cox比例风险模型、Kaplan-Meier曲线评价抗凝治疗和非抗凝治疗对1年预后的影响。根据出院及随访时抗凝情况分组,对结果进行敏感性分析。结果:共纳入664例房颤合并ACS患者,273例(41.1%)患者接受抗凝治疗,其中84例(30.8%)患者接受三联抗栓治疗,91例(33.3%)患者接受双联抗栓治疗(单一抗血小板联合抗凝药物),98例(35.9%)患者为单一抗凝治疗。共有391例(58.9%)患者仅行抗血小板治疗,其中253例(64.7%)为双联抗血小板治疗,138例(35.3%)为单一抗血小板治疗。经过抗凝治疗组与非抗凝治疗组1∶1倾向得分匹配后,共匹配到218对。多因素logistic回归分析发现,糖尿病病史、HAS-BLED评分≥3分和接受经皮冠状动脉介入治疗治疗是未抗凝治疗的独立影响因素,而缺血性卒中病史、持续性房颤是患者使用抗凝药物的独立影响因素。随访1年,抗凝治疗组中仍有218例患者(79.9%)继续进行抗凝治疗,抗血小板治疗组中仍有333例患者(85.2%)继续进行抗血小板治疗。抗凝治疗组共发生MACEs事件36例(13.2%),非抗凝治疗组共发生MACEs事件81例(20.7%)。通过Cox比例风险模型计算,发现非抗凝治疗组MACEs(HR=1.802,95%CI:1.112~2.921,P=0.017)发生风险较高,而出血事件风险并不低(HR=ObjectiveFor patients with atrial fibrillation(AF)complicated with acute coronary syndrome(ACS),both anticoagulant and antiplatelet therapy should be applied,but the use of anticoagulation therapy is still poor in these patients in China.The purpose of this study was to explore the status and adherence of antithrombotic therapy in AF patients with ACS and the impact on 1 year clinical outcomes.MethodsPatients with AF hospitalized for ACS were retrospectively included from 6 tertiary hospitals in China between July 2015 and December 2020.According to the use of anticoagulant drugs at discharge,patients were divided into two groups:anticoagulant treatment group and non-anticoagulant treatment group.Logistic regression model was used to analyze the main factors influencing the use of anticoagulant drugs in patients with atrial fibrillation complicated with ACS.Major adverse cardiac events(MACEs)were defined as all-cause death,non-fatal myocardial infarction or coronary revascularization,and ischemic stroke and Bleeding Academic Research Consortium(BARC)3 bleeding events were also collected at 1 year after discharge.After propensity score matching,Cox proportional hazards models and Kaplan-Meier analysis were used to evaluate the effect of anticoagulant treatment and non-anticoagulant treatment on 1-year prognosis.The patients were divided into different groups according to whether anticoagulation was performed at discharge and follow-up,and the sensitivity of the results was analyzed.ResultsA total of 664 patients were enrolled,and 273(41.1%)were treated with anticoagulant therapy,of whom 84(30.8%)received triple antithrombotic therapy,91(33.3%)received double antithrombotic therapy(single antiplatelet combined with anticoagulant),and 98(35.9%)received single anticoagulant therapy.Three hundred and ninety-one(58.9%)patients were treated with antiplatelet therapy,including 253(64.7%)with dual antiplatelet therapy and 138(35.3%)with single antiplatelet therapy.After 1∶1 propensity score matching between the anticoag

关 键 词：冠心病 心房颤动 抗血栓方案 

分 类 号：R541.75[医药卫生—心血管疾病] R541.4[医药卫生—内科学]