老年房颤合并冠心病的抗栓方案及再住院原因分析

Antithrombotic therapy and reason of readmission in elderly patients with atrial fibrillation combined with coronary heart disease

目的评价老年心房颤动(房颤)合并冠心病病人的抗栓治疗方案,并分析主要心血管不良事件(MACE)的发生与再住院原因。方法选取本院2013~2014年976例房颤合并冠心病病人,分成急性冠脉综合征(ACS)和稳定型冠心病(SCAD)2组并随访3年。分析2组不同卒中栓塞和出血评分下抗栓药物的选择、MACE导致再住院的发生率。结果与ACS病人首选口服双联抗血小板药物(DAPT)相比,SCAD病人更倾向于抗凝治疗(华法林或达比加群酯),2组差异有统计学意义(P<0.05)。3年随访期间,ACS组481例,115次住院,再住院率为23.9%;而SCAD组495例,176次住院,再住院率为35.5%,差异有统计学意义(P<0.05)。室性心律失常、心力衰竭及ACS是SCAD组再住院的前3位原因。心肌梗死和心力衰竭是ACS组的主要再住院原因。结论ACS合并房颤的病人主要接受DAPT治疗,而SCAD合并房颤的病人则主要行口服抗凝药物治疗。与ACS病人相比,SCAD病人有着更高的MACE发生率和再住院率。

Objective To evaluate the antithrombotic therapy in the elderly patients with atrial fibrillation combined with coronary heart disease,and to analyze the main adverse cardiovascular events(MACE)and the reasons of rehospitalization.Methods A total of 976 patients with atrial fibrillation combined with coronary heart disease from January 2013 to December 2014 in our hospital were selected,and were divided into acute coronary syndrome(ACS)group and stable coronary heart disease(SCAD)group and were followed up for 3 years.The selection of antithrombotic drugs,the incidence rate of readmission due to MACE in the two groups were compared.Results The patients in ACS group preferred dual antiplatelet therapy(DAPT),while those in SCAD group more inclined to anticoagulant therapy,and there was a significant difference between the two groups(P<0.05).In ACS group,the rate of readmission was 23.9%,compared with 35.5%in the SCAD group(P<0.05).Ventricular arrhythmia,heart failure,and ACS were the top three reasons for readmission in SCAD group.Myocardial infarction and heart failure were the main reasons of ACS group readmission.Conclusions ACS patients with atrial fibrillation tend to choose DAPT treatment,while SCAD patients tend to take oral anticoagulation therapy.Compared with ACS patients,SCAD patients have a higher MACE rate and readmission rate.