心房颤动合并冠心病患者抗栓治疗现状调查

A survey on current status of antithrombotic therapy for patients with atrial fibrillation complicated by coronary artery disease

目的回顾性调查心房颤动(房颤,AF)合并冠状动脉粥样硬化性心脏病(冠心病,CAD)患者抗栓治疗现状,分析抗栓治疗不足的相关因素。方法连续入选2016年1月1日～2016年12月31日于首都医科大学附属北京朝阳医院就诊的房颤合并冠心病患者231例,根据冠心病类型分为2组:房颤合并稳定性冠心病(SCAD)组(n=173)、房颤合并急性冠脉综合征(ACS)组(n=58);根据出血风险分为高风险组(n=139)及低风险组(n=92)。应用χ2检验比较各组临床资料及抗栓情况,应用多因素Logistic回归分析影响入院期间规范抗栓和导致出院抗栓不足的因素。结果本研究中住院期间患者规范抗栓104例(45.0%),出院规范抗栓仅66例(28.6%);房颤合并ACS组住院规范抗栓率明显高于合并SCAD组(74.1%vs. 35.3%,P<0.01);高出血风险患者住院规范抗栓率明显低于低出血风险组(32.6%vs. 53.2%,P<0.01);多因素Logistic分析结果显示,合并卒中[OR=2.427,95%CI:1.16～5.077]、合并ACS[OR=8.111,95%CI:3.862～17.033]、HAS-BLED评分[OR=0.424,95%CI:0.284～0.634]是入院规范抗栓治疗的影响因素(P<0.05)。阵发性房颤[OR=3.536,95%CI:1.803～6.935]、合并ACS[OR=3.647,95%CI:1.514～8.783]、非心内科患者[OR=3.62,95%CI:1.685～7.777]是出院抗栓不足的独立影响因素(P<0.01)。结论临床实践中,房颤合并冠心病患者抗栓规范较指南有很大差距,出血风险高低、合并冠心病类型、合并卒中、房颤类型、入院科室是影响抗栓治疗的因素。

Objective To investigate retrospectively the current status of antithrombotic therapy for patients with atrial fibrillation(AF)complicated by coronary artery disease(CAD),and analyze the factors related to underuse of antithrombotics.Methods The patients(n=231)were chosen from Beijing Chaoyang Hospital affiliated to Capital University of Medical Sciences from Jan.1,2016to Dec.31,2016.The patients were divided,according to CAD types,into AF+stable coronary artery disease group(AF+SCAD group,n=173)and AF+acute coronary syndrome group(AF+ACS group,n=58).And the patients were divided,according to bleeding risk,into high bleeding risk group(n=139)and low bleeding risk group(n=92).The clinical data and antithrombotic status were compared by usingχ^2test in all groups,and factors influencing standard antithrombotic therapy during hospitalization and factors induced underuse of antithrombotics after hospital discharge were analyzed by using multi-factor Logistic regression analysis.Results There were104patients(45.0%)with standard antithrombotic therapy during hospitalization,and only66(28.6%)with standard antithrombotic therapy after hospital discharge.The percentage of patients with antithrombotic therapy was significantly higher in AF+ACS group than that in AF+SCAD group(74.1%vs.35.3%,P<0.01)during hospitalization.The percentage of patients with antithrombotic therapy was significantly lower in high bleeding risk group than that in low bleeding risk group(32.6%vs.53.2%,P<0.01).The results of multi-factor Logistic analysis showed that complicating stroke(OR=2.427,95%CI:1.16~5.077),complicating ACS(OR=8.111,95%CI:3.862~17.033)and HAS-BLED scores(OR=0.424,95%CI:0.284~0.634)were factors influencing standard antithrombotic therapy during hospitalization(P<0.05).Paroxysmal atrial fibrillation(PAF,OR=3.536,95%CI:1.803~6.935),complicating ACS(OR=3.647,95%CI:1.514~8.783)and non-cardiologic patients(OR=3.62,95%CI:1.685~7.777)were independent factor influencing underuse of antithrombotics after hospital discharge(P<0.01).Conclusion There is substantial deviation from international guidelines in standard antithrombotic therapy use for AF+CAD patients in clinical practice,and bleeding risk,types of complicating CAD,complicating stroke,AF types,and hospital departments are independent factors influencing antithrombotic treatments.