心房細動と心筋梗塞後の死亡:コミュニティ研究
Patricia Jabre1, Xavier Jouven, Frédéric Adnet
1Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
Circulation
|May 4, 2011
まとめ
心房細動 (AF) は,心筋梗塞 (MI) の後に一般的であり,死亡リスクを大幅に増加させます. リスクは,MIの30日以上後に発症するAFが最も高い.
科学分野:
- 心臓病学 心臓病学
- 公衆衛生は公衆衛生である.
- エピデミオロジー エピデミオロジー
背景:
- 心房細動 (AF) はしばしば心筋梗塞 (MI) と共存しますが,予後に対するその影響については議論されています.
- AFとMIの死亡率に関する以前の研究は,しばしば早期入院に焦点を当て,タイミングの詳細が欠けていました.
- コミュニティベースのデータは,MI後のAFタイミングの現実世界の影響を理解するために必要です.
研究 の 目的:
- インシデントMIの患者におけるAFの発生と傾向を評価する.
- MI後の全因および心血管疾患による死亡率に対するAFの影響を定量化する.
- AFのタイミングがMIに比べて死亡リスクにどのように影響するかを判断する.
主な方法:
- コミュニティベースのコホート研究で,初めて発作した心臓発作で入院した3220人の患者 (1983年~2007年) を対象に実施した.
- AFは診断コードとEKGで特定され,全原因および心血管疾患による死亡でした.
- AFタイミングの分析による6.6年間の平均追跡期間 (前, 2日以内, 3〜30日,MI後の30日以上).
主要な成果:
- AFは,304人の患者でMIの前に,そして729人の患者でMI後に発生しました.
- MI後のAFの累積的な発生率は5年後に19%であり,時間の経過とともに変化しませんでした.
- AFは死亡リスクの3.77倍増加と関連しており,AFの発症リスクが最も高かったのは,心筋梗塞の30日後 (HR 2.58) であった.
結論:
- 心房細動は,コミュニティにおける心筋梗塞の頻繁な合併症です.
- AFは,MI後の死亡リスクを大幅に増加させる.
- AFの予後効果は,心筋梗塞の30日以上後に発症したときに最大です.
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