急性冠状动脉综合征并发一过性新发心房颤动的发病率和预后:系统回顾和荟萃分析的结果。

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2024-10-30 DOI:10.1093/ehjcvp/pvae066
Nadia Salerno, Jessica Ielapi, Angelica Cersosimo, Isabella Leo, Jolanda Sabatino, Salvatore De Rosa, Sabato Sorrentino, Daniele Torella
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引用次数: 0

摘要

背景:急性冠状动脉综合征(ACS)患者一过性新发心房颤动(AF)导致长期不良事件的总体风险仍不确定。这项荟萃分析旨在评估并发 ACS 的一过性新发房颤对预后的影响:通过对 MEDLINE、Scopus、Cochrane 和 Google Scholar 图书馆的全面检索,确定了研究 ACS 后一过性新发房颤患者与窦性心律患者不良事件风险的队列研究。纳入的研究报告了缺血性中风事件、复发性房颤或最长随访期间全因死亡率的发生率。采用反方差加权随机效应荟萃分析法对调整后的危险比 (aHR) 及 95% 置信区间 (CI) 进行了综合分析。在纳入的 7 项观察性研究(包括 151 735 名患者)中,有 6 597 人(4.3%)经历过短暂性新发房颤,这与缺血性卒中、复发性房颤或全因死亡风险增加有关(HR:2.24,95% CI:1.75-2.85;P 结论:新发房颤与缺血性卒中、复发性房颤或全因死亡风险增加有关:一过性新发房颤的发生与 ACS 患者中风、复发性房颤和全因死亡的长期风险升高有关。因此,这些数据敦促进行随机临床试验,以评估最佳抗血栓治疗方案,同时为这些患者目前的治疗决策过程提供潜在帮助。
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Incidence and outcomes of transient new-onset atrial fibrillation complicating acute coronary syndromes: results from a systematic review and meta-analysis.

Background: The overall risk of long-term adverse events of a transient episode of new-onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS) remains uncertain. This meta-analysis aimed to assess the prognostic impact of transient new-onset AF complicating ACS.

Methods and results: Cohort studies examining the risk of adverse events in patients with transient new-onset AF compared to those in sinus rhythm after ACS were identified through a comprehensive search of MEDLINE, Scopus, Cochrane, and Google Scholar Library. Studies reporting the incidence of ischaemic stroke events, recurrent AF, or all-cause mortality at the longest follow-up were included. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CI) were synthesized using inverse variance-weighted random-effects meta-analysis. In the seven observational studies included, comprising 151 735 patients, 6 597 (4.3%) experienced transient new-onset AF, which was associated with an increased risk of ischaemic stroke, recurrent AF, or all-cause mortality (HR: 2.24, 95% CI: 1.75-2.85; P < 0.0001; I2 = 30.76%; seven studies). The results remained consistent across each individual endpoint, including ischaemic stroke (HR 2.38, 95% CI: 1.64-3.44; P < 0.01; I2 = 50.2%; five studies), recurrent AF (HR 4.68, 95% CI: 2.07-10.59; P = 0.0002; I2 = 50.2%; four studies), and all-cause mortality (HR 1.36, 95% CI: 1.08-1.71; P = 0.0089; I2 = 53.25%; four studies). Meta-regression analyses revealed a significant increase in these adverse events associated with ST-elevation myocardial infarction (P = 0.001), while there was a tendency for their decrease associated with oral anticoagulant prescription at discharge (P = 0.07).

Conclusions: The occurrence of transient new-onset AF is associated with an elevated long-term risk of stroke, recurrent AF, and all-cause mortality in patients with ACS. Consequently, these data urge randomized clinical trials to assess the best antithrombotic regimen while potentially helping the current treatment decision-making process for these patients.

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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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