在患有心房和高并发症的患者中早期节律控制
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
概括
早期节律控制 (ERC) 对心房动和中风高风险的患者有好处 (CHA2DS2- VASc评分≥4). 然而,ERC可能会增加一些并发症的患者 (CHA2DS2- VASc评分< 4).
科学领域:
- 心脏病学
- 临床试验
- 前庭的管理
背景情况:
- 在EAST- AFNET4试验中,早期节律控制 (ERC) 降低了近期发作的心房动 (AF) 和中风风险因素的心血管事件.
- 在患有多种心血管并发症的患者中,ERC的有效性和安全性尚不清楚.
研究的目的:
- 在患有较高 (CHA2DS2- VASc评分≥4) 和较低并发症负担的患者中,比较ERC与常规治疗 (UC) 的有效性和安全性.
- 根据并发症负担分层分析ERC结果.
主要方法:
- 预先指定的EAST-AFNET4试验的子分析.
- 患者分为较高 (CHA2DS2- VASc评分≥4) 和较低 (CHA2DS2- VASc评分<4) 的并发症组.
- 对ERC与UC的疗效 (综合初级疗效结果) 和安全性 (初级安全性结果) 在分层内进行了比较.
主要成果:
- 在并发症负担较高的患者中 (CHA2DS2- VASc评分≥4),ERC显著降低了初级疗效结果 (HR,0. 64;P < 0. 001),而没有增加初级安全结果 (HR,0. 84;P=0. 175).
- 在并发症负担较低的患者中 (CHA2DS2- VASc评分< 4),ERC没有降低初级疗效结果 (HR,0. 93;P=0. 56) 并增加初级安全结果 (HR,1. 39;P=0. 019).
- 在忽略女性性别时,性别分层分析显示了安全结果的显著相互作用 (P=0. 044).
结论:
- 早期节律控制 (ERC) 建议在最近被诊断为心房动且CHA2DS2- VASc得分为4或更高的患者中进行,以减少不良心血管结果.
- 与常规治疗相比,患有较少并发症 (CHA2DS2- VASc评分< 4) 的患者可能会经历较不良的治疗结果和增加的安全风险.
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