急性心肌梗死后房颤/房扑患者发生猝发性和非猝发性心血管死亡的风险增加

查看全文 作　　者：Pedersen [1]O.D;AbildstrΦm S.Z;Ottesen M.M.;王海玲 机构地区：[1]Department of Cardiology Y, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark 出　　处：《世界核心医学期刊文摘(心脏病学分册)》索引2006年第2卷第5期,共2页 摘　　要：Aims: Atrial fibrillation(AF) is a common complication in patients with acute myocardial infarction and is associated with an increase in the risk of death. The excess mortality associated with AF complicating acute myocardial infarction has not been studied in detail. Observations indicate that AF facilitates induction of ventricular arrhythmias, which may increase the risk of sudden cardiovascular death(SCD). A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments. Methods and results: We analysed the relation between AF/atrial flutter(AFL) and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infarction screened in the TRAndolapril Cardiac Evaluation registry. This cohort of patients with an enzyme-verified acute myocardial infarction was admitted to 27 centres in 1990- 92. Survival status was obtained 2 years after screening of the last patient. An independent endpoint committee assessed the modes of death. Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospectively collected. Sustained or paroxysmal AF/AFL was observed in 1149 patients(19% ) during hospitalization. During follow-up, 1659 patients(34% ) died: 482(50% ) patients with AF/AFL and 1177(30% ) patients without AF/AFL, P< 0.001. SCD occurred in 536, non-SCD occurred in 725, and 398 died of non-cardiovascular causes(includes 142 unclassifiable cases). The adjusted risk ratio of AF/AFL for total mortality was 1.33(95% CI: 1.19- 1.49; P < 0.0001) and the risk ratio for SCD was 1.31(95% CI: 1.07- 1.60; P < 0.009). The adjusted risk ratio of AF/AFL for non-SCD was 1.43(95% CI: 1.21- 1.70; P < 0.0001). Conclusion: The excess mortality observed in patients with AF/AFL following acute myocardial infarction is due to a significant increase in both SCD and non-SCD. 关 键 词：死亡风险 急性心肌梗死后 阵发性 急性心肌梗死(AMI) 心血管 患者 房扑 房颤 常见并发症 室性心律失常