アトリアルフィブリレーションと高併発症の患者の早期リズム制御
Andreas Rillig1,2, Katrin Borof1, Günter Breithardt3,4
1Department of Cardiology, University Heart and Vascular Center (A.R., K.B., A.M., P.K.), University Medical Center Hamburg-Eppendorf, Germany.
Circulation
|August 15, 2022
まとめ
早期リズムコントロール (ERC) は,心房細動と脳卒中リスクが高い患者 (CHA2DS2- VAScスコア ≥4) に有益です. しかし,併発症が少ない患者では,ERCが有害事象を増加させる可能性があります (CHA2DS2- VAScスコア< 4).
科学分野:
- 心臓病科
- 臨床試験
- アトリアルフィブリレーションの管理
背景:
- EAST- AFNET4試験では,脳卒中の危険因子のある,最近発症した心房細動 (AF) の場合,早期リズムコントロール (ERC) が心血管疾患を減少させることが示されました.
- 複数の併発性心血管疾患を有する患者のERCの有効性と安全性は不明である.
研究 の 目的:
- 高い (CHA2DS2- VAScスコア ≥4) と低い併発症の患者におけるERCと通常の治療 (UC) の有効性と安全性を比較する.
- 併発症の負担によって層分けされたERCの結果を分析する.
主な方法:
- EAST-AFNET4試験の予め指定されたサブ分析
- 患者は,より高い (CHA2DS2- VAScスコア ≥4) およびより低い (CHA2DS2- VAScスコア < 4) 併発症群に分類された.
- ERC と UC の有効性 (複合的原始有効性結果) と安全性 (原始安全性結果) は,層内で比較されました.
主要な成果:
- CHA2DS2- VAScスコア ≥4の併発性重症患者では,ERCは,主効性評価値 (HR,0. 64; P < 0. 001) を著しく低下させ,主安全性評価値 (HR,0. 84; P=0. 175) を増加させなかった.
- 併発性重症 (CHA2DS2- VAScスコア< 4) の患者では,ERCは主効性アウトカム (HR,0. 93; P=0. 56) を低下させず,主安全性アウトカム (HR,1. 39; P=0. 019) を増加させた.
- 性別別別分析では,女性の性別を無視した安全性に関する有意な相互作用が示された (P=0. 044).
結論:
- 最近診断された心房細動とCHA2DS2- VAScスコアが4以上である患者に,心血管不良を減らすために早期のリズムコントロール (ERC) が推奨されます.
- 併発症が少ない患者 (CHA2DS2- VAScスコア < 4) は,通常の治療と比較して,ERCで好ましい結果と安全性のリスクが増加することがあります.
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