真实世界心房颤动合并急性冠脉综合征抗栓策略变迁与心源性卒中的关系  

Trends of different antithrombotic strategies and its association with cardiogenic stroke in atrial fibrillation patients with acute coronary syndrome:a real-world study

作　　者：梁翰阳 张晗 邵兴慧 王娟 吴双 任佳梦 索妮 莫然 吕思奇 徐唯 王璐璐 谭江山 王景阳 王一萌 舒玉源 孙格 辛宜静 杨艳敏 Liang Hanyang;Zhang Han;Shao Xinghui;Wang Juan;Wu Shuang;Ren Jiameng;Suo Ni;Mo Ran;Lyu Siqi;Xu Wei;Wang Lulu;Tan Jiangshan;Wang Jingyang;Wang Yimeng;Shu Yuyuan;Sun Ge;Xin Yijing;Yang Yanmin(Emergency and Intensive Care Center,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,Key Laboratory of Molecular Cardiovascular Science,Ministry of Education,Beijing 100191,China;Department of Cardiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室阜外医院急重症中心,北京100037 [2]北京大学第三医院心内科、血管医学研究所、北京大学分子心血管学教育部重点实验室,北京100191 [3]首都医科大学附属北京朝阳医院心内科,北京100020 [4]首都医科大学宣武医院神经内科,北京100053

出　　处：《中华心律失常学杂志》2024年第1期49-56,共8页Chinese Journal of Cardiac Arrhythmias

基　　金：首都临床诊疗技术研究及示范应用(Z191100006619121);国家心血管疾病临床医学研究中心自主课题(NCRC2020015)。

摘　　要：目的探究真实世界心房颤动(房颤)合并急性冠脉综合征(ACS)人群的抗栓策略变迁及其对心血管不良事件的影响。方法本研究为单中心、前瞻性、观察性研究。选取2017—2019年于中国医学科学院阜外医院就诊的房颤合并ACS患者,根据抗栓策略分为抗凝治疗组与未抗凝治疗组,根据就诊时间将研究人群分为2017年组、2018年组、2019年组。对所有患者开展1年随访,主要终点为心源性卒中,次要研究终点为随访1年内发生主要不良心血管事件(MACCE),定义为全因死亡、心源性卒中、非中枢神经系统的体循环栓塞、心肌梗死、靶血管血运重建、缺血驱动的血运重建。结果共入选1333例房颤合并ACS患者,其中男922例,年龄(68.3±9.7)岁。其中接受抗凝治疗患者534例(抗凝治疗组),未接受抗凝治疗患者799例(未抗凝治疗组)。与未抗凝治疗组相比,抗凝治疗组患者的CHA_(2)DS_(2)-VASc评分更高[(3.7±1.9)分对(4.3±1.8)分,P<0.001]。2017—2019年,接受抗凝治疗(P<0.001,P for trend<0.001)、口服抗凝药(OAC)+单药抗血小板治疗(SAPT)双联抗栓治疗(P=0.018,P for trend=0.006)以及OAC+双联抗血小板治疗(DAPT)三联抗栓治疗(P<0.001,P for trend<0.001)的比例均逐年增加。主要终点方面,未抗凝治疗组1年内发生心源性卒中5例(0.6%,5/799),抗凝治疗组1年内发生心源性卒中19例(3.6%,19/534),Log-rank检验提示两者差异有统计学意义(P<0.001)。2017年组发生心源性卒中10例(2.3%,10/429),2018年组发生心源性卒中9例(1.6%,9/573),2019年组发生心源性卒中5例(1.5%,5/331),Log-rank检验提示3者差异无统计学意义(P=0.604)。次要终点方面,未抗凝治疗组1年内发生MACCE事件75例(9.4%,75/799),抗凝治疗组1年内发生心源性卒中85例(15.9%,85/534),Log-rank检验提示差异存在统计学意义(P<0.001)。2017年组发生MACCE事件48例(11.2%,48/429),2018年组发生MACCE事件72例(12.6%,72/573),2019年组发生MACCE事件40�Objective To analyze the antithrombotic strategies in patients with atrial fibrillation(AF)combined with acute coronary syndrome(ACS),and their adverse cardiovascular events in real-world practice.Methods This research was a single-center,prospective,observational study.The patients with AF combined with ACS from Chinese Academy of Medical Sciences Fuwai Hospital between 2017 and 2019 were selected,and were divided into anticoagulant therapy and non-anticoagulant therapy groups by physician′experience and patients′intention,and were also divided into 2017,2018,and 2019 groups according to the time of consultation.One year follow-up was conducted for all patients,with the primary endpoint of cardiogenic stroke.The secondary study endpoint was defined as major adverse cardiovascular events(MACCE),including all-cause death,cardiogenic stroke,non-central nervous system embolism of the corpuscular circulation,myocardial infarction,target vessel revascularization,and ischemia-driven revascularization.Results A total of 1333 patients with AF combined with ACS were enrolled in this study.Nine hundred and twenty-two patients were male,the average age was 68.3±9.7.Among them,534 patients received anticoagulation therapy,and 799 patients did not receive anticoagulation therapy.Compared with non-anticoagulant group,anticoagulant group had higher CHA_(2)DS_(2)-VASc score(3.7±1.9 vs.4.3±1.8,P<0.001).Between 2017 and 2019,patients who received anticoagulation(P<0.001,P for trend<0.001),dual antithrombotic therapy with oral anticoagulants(OAC)+single antiplatelet therapy(SAPT,P=0.018,P fort rend=0.006),and triple antithrombotic therapy with OAC+dual antiplatelet therapy(DAPT,P<0.001,P for trend<0.001)increased by years.In terms of primary endpoint,cardiogenic stroke occurred in 5 patients(0.6%,5/799)in the non-anticoagulant group,and 19 patients(3.6%,19/534)in the anticoagulant group.Log-rank test indicated that the difference was statistically significant(P<0.001).Cardiogenic stroke occurred in 10 patients(2.3%,10/429)in

关 键 词：心房颤动 急性冠脉综合征 心源性卒中 抗栓治疗 抗凝 

分 类 号：R541[医药卫生—心血管疾病]