回顾性分析利伐沙班对老年心房颤动合并稳定性冠状动脉粥样硬化性心脏病患者结局的影响

Retrospectively analysis on rivaroxaban on outcomes of in elderly patients with atrial fibrillation and stable coronary artery disease

目的回顾性分析不同剂量利伐沙班对老年心房颤动(atrial fibrillation,AF)合并稳定性冠状动脉粥样硬化性心脏病(stable coronary artery disease,SCAD)患者的肾功能结局及预后的影响。方法回顾性分析2018年1月~12月在我院接受利伐沙班治疗(≥3个月)AF合并SCAD的老年患者(≥65岁)416例的临床资料,根据初始用药剂量分为低剂量组(<10 mg/d)、常规剂量组(10~15 mg/d)和高剂量组(20 mg/d)。治疗的主要有效终点包括心血管相关死亡、心肌梗死、缺血性卒中/短暂性脑缺血发作、肺栓塞及下肢深静脉血栓等。治疗主要安全性终点为出血事件和肾功能损害的发生。结果3组患者基线血肌酐清除率和利伐他班用药时间存在统计学差异(P<0.05)。随访期间,高剂量组AKD发生率高于低剂量组(P<0.05)。经单因素和多变量logistic回归模型分析,并校正利伐沙班用药时间和初始血清肌酐清除率后,利伐他班20 mg/d为AF合并SCAD患者发生肾功能损害的独立危险因素(比值比=3.579,95%置信区间:1.879~9.974),且对于基础血清肌酐清除率50~79 ml/min或≥80 ml/min的患者,利伐他班20 mg/d都会增加AF合并SCAD患者肾功能损害的发生风险(比值比=6.876,95%置信区间:2.647~14.652;比值比=2.159,95%置信区间:1.042~5.477);此外,对于基础血清肌酐清除率50~79 ml/min者,利伐他班常规剂量(10~15 mg/d)也会增加AF合并SCAD患者发生肾功能损害的风险(比值比=1.254,95%置信区间:1.001~1.959)。结论利伐沙班20 mg/d会增加既往接受过经皮冠状动脉介入术的AF合并SCAD老年患者肾功能损害的发生风险。

Objective To retrospectively analyze the effects of different doses of rivaroxaban on renal function outcome and prognosis in elderly patients with atrial fibrillation(AF)combined with stable coronary artery disease(SCAD).Methods A total of 416 elderly(≥65 years old)AF-SCAD patients who received rivaroxaban treatment(≥3 months)in our hospital from January to December 2018 were retrospectively analyzed,and divided into low-dose group(<10 mg/d),conventional-dose group(10-15 mg/d)and high-dose group(20 mg/d)according to the initial dose.The primary effective end points of treatment included cardiovascular death,myocardial infarction,ischemic stroke/transient ischemic attack,pulmonary embolism and deep venous thrombosis of the lower extremities.The primary safety end points were bleeding events and acute kidney disease(AKD).Results There were statistically significant differences in baseline creatinine clearance and medication time of rivaroxaban among the three groups(P<0.05).The incidence of AKD in the high-dose group was higher than that in the low-dose group during follow-up(P<0.05).Univariate and multivariate logistic regression analysis showed that after adjusting the time of administration of rivaroxaban and the initial serum creatinine clearance,rivaroxaban 20 mg/d was still an independent risk factor for AKD in patients with AF-SCAD(odds rate=3.579,95%confidence interval:1.879-9.974),and also the independent risk factor for AKD in patients with baseline serum creatinine clearance of 50-79ml/min or≥80ml/min(odds rate=6.876,95%confidence interval:2.647-14.652,odds rate=2.159,95%confidence interval:1.042-5.477).In addition,for patients with baseline serum creatinine clearance of 50-79ml/min,the conventional dose of rivaroxaban(10-15 mg/d)also increase the risk of AKD in patients with AF-SCAD(odds rate=1.254,95%confidence interval:1.001-1.959).Conclusion Rivaroxaban 20 mg/d can increases AKD risk in elderly patients with AF-SCAD and received percutaneous coronary intervention.