冠心病合并心房颤动患者经皮冠状动脉介入术后的长期预后分析

Long-term prognosis of coronary artery disease with atrial fibrillation after percutaneous coronary intervention

目的探讨分析冠心病合并心房颤动患者经皮冠状动脉介入术（PCI）后的长期预后。方法在2013年阜外医院全部10 724例PCI患者中，比较房颤与非房颤患者2年临床预后。结果共113例患者合并心房颤动（1.1%），其中8人为三联抗栓治疗（9.5%），房颤组患者合并症更多；2年随访结果显示，房颤组全因死亡率明显高于非房颤组（9.7%比1.1%；P〈0.001），心源性死亡、支架血栓、脑卒中的发生率也明显高于非房颤组，MACCE的发生率同样显示房颤组明显高于非房颤组（17.7%比8.8%；P〈0.001），而血运重建的发生率却明显低于非房颤组（2.7%比8.7%；P＝0.023），两组心肌梗死和出血的发生率差异无统计学意义，但经倾向性评分调整后，两组之间的不良事件无显著差异。结论房颤患者的预后差于非房颤患者，临床基线经匹配后两组之间预后则无差异，但该结论还需要随机对照研究证实。

ObjectiveTo investigate the long-term prognosis of coronary artery disease with atrial fibrillation （AF） after percutaneous coronary intervention （PCI）.MethodsA total of 10 724 patients with PCI were enrolled in 2013, and 2-year clinical outcomes in patients with AF （AF group） and without AF （non-AF group） were compared.ResultsA total of 113 patients were with AF （1.1%）, and 8 out of them were on triple antithrombotic therapy （9.5%）, and AF group patients were with more complications. The 2-year follow-up results showed that the all-cause mortality in AF group was significantly higher than that in non-AF group （9.7% vs 1.1%; P〈0.001）. The incidence of cardiac death, stent thrombosis and stroke was also significantly higher in patients with AF. The incidence of major adverse cardiac and cerebrovascular events （MACCE） was also significantly higher in AF group compared with non-AF group （17.7% vs 8.8%; P〈0.001）, whereas the incidence of revascularization was significantly lower in the AF group than in the non-AF group （2.7% vs 8.7%; P=0.023）. The incidence of myocardial infarction and bleeding had no significant difference between the two groups, and the adverse events between the two groups had no significant difference after propensity score （PS） either.ConclusionsThe 2-year clinical follow-up of single-center, large-sample PCI patients shows poor prognosis in patients with AF compared with the non-AF patients. But there is no difference in the prognosis between the two groups after PS, however, this conclusion still needs to be confirmed by randomized controlled studies.