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目的探讨心房颤动(房颤)合并有冠状动脉粥样硬化性心脏病(冠心病)病史的患者临床特征及一年随访的主要临床事件。方法连续性入选由2008年11月至2011年10月在全国20家医院急诊就诊的所有房颤患者,记录患者的基线资料及治疗情况;对患者进行1年随访,主要终点事件包括随访一年内发生的全因死亡、卒中、非中枢性栓塞及大出血事件。按照患者既往合并冠心病史分成二组:冠心病组和非冠心病组。结果共入选1947名房颤患者,其中40.5%的患者合并有冠心病史。冠心病组患者年龄较高、男性比例较高,入院时心率水平较慢。冠心病组CHADS2评分明显高于非冠心病组(2.4±1.4比1.4±1.2;P<0.001),在随访阶段服用华法林的患者在两组所占比例均较低,但非冠心病组服用华法林的比例较高于冠心病组(16.8%比12.9%;P=0.017)。在终点事件发生方面,冠心病组在全因死亡(16.8%比12.9%;P=0.019)及卒中(9.0%比6.4%;P=0.030)所占比例较高,而非中枢性栓塞及大出血事件的发生在两组中未见显著差异。多因素Cox回归模型分析显示,冠心病史是1年全因死亡(HR=1.35,95%CI:1.01-1.80,P=0.040)的独立危险因素,而不是卒中事件(HR=1.07,95%CI:0.72-1.58,P=0.736)发生的危险因素。结论冠心病常并发于房颤,冠心病史是致全因死亡的独立危险因素,在中国这部分患者缺乏足够的抗血栓治疗,所以应对此类患者引起重视并加强抗血栓等相关治疗。
Objective To investigate the clinical characteristics of patients with atrial fibrillation (CAD) complicated with coronary heart disease (CHD) and the main clinical events at one year follow-up. Methods All patients with AF who visited the emergency department of 20 hospitals in China from November 2008 to October 2011 were enrolled in the study. The baseline data and treatment of patients were recorded. Patients were followed up for 1 year. The main endpoints included follow-up of one year All-cause death, stroke, non-central embolism, and major bleeding. According to the history of patients with previous coronary heart disease divided into two groups: coronary heart disease group and non-coronary heart disease group. Results A total of 1947 AF patients were enrolled, of whom 40.5% had a history of coronary heart disease. Coronary heart disease patients were older, a higher percentage of males and had a slower heart rate at admission. CHADS2 scores in CHD group were significantly higher than those in non-CHD group (2.4 ± 1.4 vs. 1.4 ± 1.2; P <0.001). The proportion of patients taking warfarin during the follow-up period was lower in both groups, but non-CHD group The rate of taking warfarin was higher in the CHD group (16.8% vs. 12.9%; P = 0.017). The incidence of coronary heart disease was higher in all patients with coronary heart disease (16.8% vs 12.9%; P = 0.019) and stroke (9.0% vs 6.4%; P = 0.030), but not for central embolism or major bleeding The occurrence of the incident did not show any significant difference between the two groups. In the multivariate Cox regression model analysis, the history of coronary heart disease was an independent risk factor for all-cause death (HR = 1.35, 95% CI: 1.01-1.80, P = 0.040) for 1 year rather than stroke (HR = 1.07, 95% CI: 0.72-1.58, P = 0.736). Conclusions Coronary heart disease is often complicated by atrial fibrillation. The history of coronary heart disease is an independent risk factor for all-cause mortality. In China, there is a lack of sufficient anti-thrombosis treatment in these patients. Therefore, such patients should pay more attention to antithrombotic therapy.