不同心房颤动类型与心力衰竭合并非ST段抬高型急性冠状动脉综合征预后的相关性分析  

Analysis of the correlation between atrial fibrillation types and prognosis in patients with heart failure complicated by non-ST elevation acute coronary syndrome

作　　者：刘沛璇 马晓海[2] 李晓萌 许斌[1] LIU Peixuan;MA Xiaohai;LI Xiaomeng;XU bin(Department of Anesthesia Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung,and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉手术中心,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所介入诊疗科,100029

出　　处：《心肺血管病杂志》2024年第7期688-694,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探究在射血分数降低型心力衰竭(heart failure with reduced ejection fraction,HFrEF)合并非ST段抬高型急性冠状动脉综合征(on-ST elevation acute coronary syndrome,NSTEACS)人群中,不同心房颤动(atrial fibrillation,AF)类型与预后的相关性。方法:本研究为单中心回顾性队列研究,最终入选HFrEF合并NSTE-ACS行PCI治疗的患者866例。所有患者根据入院时AF的类型分为三组:无AF组(n=585),阵发性AF组(n=198)和持续性/永久性AF组(n=83)。主要终点:主要不良心血管事件(major adverse cardiovascular events,MACE)。次要终点:主要终点的组成部分,包括:心血管死亡、非致死性心肌梗死(myocardial infarction,MI)、HF再住院。随访时间为3年。采用生存分析明确不同AF类型与各结局间的关系。通过多元Cox回归分析探索不同AF类型对结局发生风险的影响。结果:持续性/永久性AF组的主要结局及次要结局的发生率明显高于无AF组及阵发性AF组(P均<0.05)。生存分析表明:持续性/永久性AF组MACE、非致死性MI及HF再住院3年复合发生率显著高于无AF组及阵发性AF组(Log-rank P均<0.05)。多元Cox回归分析表明:持续性/永久性AF组MACE发生风险显著高于无AF组(HR=2.19,95%CI:1.53~3.12,P<0.001)及阵发性AF组(HR=1.55,95%CI:1.03~2.32,P=0.035)。结论:在HFrEF合并NSTEACS行PCI的患者中,持续性/永久性AF患者MACE发生风险显著高于无AF组及阵发性AF组。Objective:To investigate the prognostic impact of different atrial fibrillation(AF)types on patients with heart failure with reduced ejection fraction(HFrEF)and non-ST elevation acute coronary syndrome(NSTE-ACS).Methods:In this single-center retrospective cohort study,866 patients with HFrEF and NSTE-ACS,all treated with PCI,were categorized based on their AF status at admission:no-AF(n=585),paroxysmal AF(n=198),and persistent/permanent AF(n=83).The primary endpoint was the occurrence of major adverse cardiovascular events(MACE),while secondary endpoints included individual components of MACE-cardiovascular death,non-fatal myocardial infarction(MI),and HF rehospitalization.Over a 3-year follow-up period,survival analysis was employed to ascertain the association between AF types and clinical outcomes.Multivariate Cox regression analysis was utilized to assess the impact of AF types on the risk of these outcomes,with results expressed as hazard ratios(HR)and 95%confidence intervals(CI).Results:The study revealed that both primary and secondary outcomes were significantly more prevalent in the persistent/permanent AF group compared to the no-AF and paroxysmal AF groups(P<0.05).Survival analysis elucidated that the 3-year cumulative incidence of MACE,non-fatal MI,and HF rehospitalization was notably higher in the persistent/permanent AF group(Log-rank P<0.05).Further,multivariate Cox regression highlighted that the persistent/permanent AF group bore a significantly escalated risk of MACE compared to the no-AF group(HR=2.19,95%CI:1.53-3.12,P<0.001)and the paroxysmal AF group(HR=1.55,95%CI:1.03-2.32,P=0.035).Conclusions:Among patients with HFrEF complicated by NSTE-ACS and undergoing PCI,the presence of persistent/permanent AF was associated with a substantially heightened risk of MACE,underscoring the need for tailored therapeutic strategies in this high-risk cohort.

关 键 词：心房颤动 射血分数降低型心力衰竭 非ST段抬高型急性冠状动脉综合征 经皮冠状动脉介入治疗 主要不良心血管事件 

分 类 号：R54[医药卫生—心血管疾病]