急性冠状动脉综合征患者合并心房颤动的相关因素及抗凝治疗情况研究

Related factors and anticoagulant therapy status in patients with acute coronary syndrome complicated with atrial fibrillation

目的探讨急性冠状动脉综合征(ACS)患者合并心房颤动的相关因素及抗凝治疗情况。方法纳入2018年1月至2020年2月首都医科大学附属北京安贞医院诊断为ACS的患者46 556例,根据是否诊断为心房颤动分为合并心房颤动患者(心房颤动组)和未合并心房颤动患者(对照组)。比较2组临床资料,分析ACS患者合并心房颤动的影响因素。分析ACS合并心房颤动患者的抗凝治疗情况。结果 46 556例患者中心房颤动组1 353例(2.9%),对照组45 203例(97.1%)。多因素分析结果显示,年龄、高血压、脑梗死、甲状腺功能异常、体重指数、血小板计数、D-二聚体、左心室舒张末期内径、E波最大流速、A波最大流速是ACS患者合并心房颤动的独立影响因素(均P<0.05),其中年龄是ACS患者合并心房颤动的最强相关因素。合并心房颤动的ACS患者中,仅有30.7%(415/1 353)启动了抗凝治疗,其余69.3%(938/1 353)的患者仅使用抗血小板治疗或未使用任何抗凝或抗血小板药物。结论年龄是ACS患者合并心房颤动的最强相关因素。ACS合并心房颤动患者抗凝治疗仍处于十分不足的状态。

Objective To investigate the related factors and anticoagulant therapy status in patients with acute coronary syndrome(ACS) complicated with atrial fibrillation. Methods Totally 46 556 patients with ACS diagnosed in Beijing Anzhen Hospital, Capital Medical University from January 2018 to February 2020 were included. According to whether complicated with atrial fibrillation, they were divided into patients with atrial fibrillation(atrial fibrillation group) and patients without atrial fibrillation(control group). The clinical data of the two groups were compared to analyze the influencing factors of ACS patients complicated with atrial fibrillation. The anticoagulant treatment of ACS patients with atrial fibrillation was analyzed. Results Of the 46 556 patients, 1 353 patients(2.9%) were divided into atrial fibrillation group and 45 203 patients(97.1%) were divided into control group. Multivariate analysis showed that age, hypertension, cerebral infarction, abnormal thyroid function, body mass index, platelet count, D-dimer, left ventricular end diastolic diameter, maximum velocity of E wave and maximum velocity of A wave were independent influencing factors of ACS patients complicated with atrial fibrillation(all P<0.05), and age was the strongest related factor of them. Among ACS patients complicated with atrial fibrillation, only about 30.7%(415/1 353) started anticoagulant therapy, and the remaining 69.3%(938/1353) only used antiplatelet therapy or did not use any anticoagulant or antiplatelet drug. Conclusions Age is the strongest factor associated with atrial fibrillation in ACS patients. Anticoagulant therapy for patients with ACS complicated with atrial fibrillation is still insufficient.