既往及新发心房颤动对急性心肌梗死患者远期卒中风险的影响  

The effects of preexisting and new-onset atrial fibrillation on the long-term risk of stroke in patients with acute myocardial infarction

作　　者：郑屹 刘莹[1] 张煜坤 李广平[1] 陈康寅[1] 刘彤[1] Zheng Yi;Liu Ying;Zhang Yukun;Li Guangping;Chen Kangyin;Liu Tong(Department of Cardiology,Tianjin Key Laboratory of lonic-Molecular Function of Cardiovascular Disease,Tianjin Institute of Cardiology,Second Hospital of Tianjin Medical University,Tianjin 3002ll,China)

机构地区：[1]天津医科大学第二医院心脏科、天津市心血管病离子与分子机能重点实验室、天津心脏病学研究所,300211

出　　处：《中华脑血管病杂志（电子版）》2024年第5期406-417,共12页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：国家自然科学基金(82170327);天津市医学重点学科(专科)建设项目(TJYXZDXK-029A,TJWJ2022XK013)。

摘　　要：目的比较既往及新发心房颤动(AF)对急性心肌梗死(AMI)患者远期卒中风险的影响。方法纳入2016年8月至2023年6月天津市72家二、三级医院出院诊断包含AMI及AF的患者。将研究人群分为入院前有AF诊断的患者(既往AF组)和入院前没有诊断AF的患者(新发AF组)。主要结局包括卒中、缺血性卒中和出血性卒中,次要结局包括全因死亡、心血管死亡、所有原因出血和大出血。采用多变量Cox回归和Kaplan-Meier生存曲线分析既往和新发AF对AMI患者结局的影响。对既往及新发AF患者进行1∶1倾向性评分匹配,并进行亚组分析与多因素竞争风险分析。结果共纳入5530例患者,其中1819例为既往AF患者,3711例为新发AF患者。多变量Cox回归分析显示,新发与既往AF患者卒中(HR=1.10,95%CI:0.98~1.23,P=0.103)、缺血性卒中(HR=1.10,95%CI:0.98~1.23,P=0.092)、出血性卒中(HR=0.99,95%CI:0.64~1.54,P=0.959)、全因死亡(HR=0.94,95%CI:0.84~1.06,P=0.342)、心血管死亡(HR=1.04,95%CI:0.89~1.21,P=0.626)、所有原因出血(HR=1.03,95%CI:0.88~1.20,P=0.729)及大出血(HR=0.75,95%CI:0.52~1.07,P=0.115)等结局的风险无明显差异。按1∶1进行倾向性评分匹配后,2组各纳入1452例患者。Kaplan-Meier生存曲线分析显示,与既往AF相比,新发AF患者卒中(P=0.130)、缺血性卒中(P=0.120)、出血性卒中(P=0.560)、全因死亡(P=1.000)、心血管死亡(P=0.062)、所有原因出血(P=0.220)和大出血(P=0.500)的发生风险无显著差异。结论新发AF合并AMI患者与既往AF合并AMI患者预后相当,同样需重视其卒中、缺血性卒中、出血性卒中、死亡、心血管死亡、所有原因出血和大出血的风险。Objective To assess and compare the long-term risk of stroke in patients with acute myocardial infarction(AMI)who have preexisting versus new-onset atrial fibrillation(AF).Methods Patients diagnosed with AMI and AF from 72 secondary and tertiary hospitals in Tianjin,China,between August 2016 and June 2023 were enrolled.The study population was divided into those with a prior diagnosis of AF(preexisting AF group)and those without a prior diagnosis of AF(new-onset AF group).The primary outcomes included stroke,ischemic stroke,and hemorrhagic stroke,with secondary outcomes induding all-cause mortality,cardiovascular mortality,all bleeding and major bleeding.Multivariate Cox regression and Kaplan-Meier survival curves were used to analyze the effects of preexisting and new-onset AF on the outcomes in patients with AMI.Propensity score matching with a 1∶1 ratio for preexisting AF versus newonset AF was performed.Additionally,subgroup analyses and multivariable competing risk analyses were performed.Results A total of 5530 patients were identified,comprising 1819 with preexisting AF patients and 3711 with new-onset AF.Multivariate Cox regression showed no significant differences in the risk of stroke(HR=1.10,95%CI:0.98-1.23,P=0.103),ischemic stroke(HR=1.10,95%CI:0.98-1.23,P=0.092),hemorrhagic stroke(HR=0.99,95%CI:0.64-1.54,P=0.959),all-cause mortality(HR=0.94,95%CI:0.84-1.06,P=0.342),cardiovascular mortality(HR=1.04,95%CI:0.89-1.21,P=0.626),all bleeding(HR=1.03,95%CI:0.88-1.20,P=0.729)or major bleeding(HR=0.75,95%CI:0.52-1.07,P=0.115)between patients with preexisting AF and new-onset AF.After 1∶1 propensity score matching,1452 preexisting AF patients and 1452 new-onset AF patients were included.Kaplan-Meier survival curves showed that compared with preexisting AF,there was no significant difference in the risk of stroke(P=0.130),ischemic stroke(P=0.120),hemorrhagic stroke(P=0.560),all-cause death(P=1.000),cardiovascular death(P=0.062),all bleeding(P=0.220),or major bleeding(P=0.500)in patients with new-onset AF.Con

关 键 词：心房颤动 急性心肌梗死 卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]