冠状动脉手术和中风风险后的新发性心房动:全国性的队列研究
Amar Taha1,2, Andreas Martinsson3,2, Susanne J Nielsen3,4
1Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden amar.taha@gu.se.
Heart (British Cardiac Society)
|October 4, 2024
概括
在冠状动脉旁路移植 (CABG) 后的术后心房动 (POAF) 增加了中风风险. 关键因素包括先前的中风,年龄,心力衰竭和心肌梗塞,OAC泄漏不反映风险.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 公共卫生 公共卫生
背景情况:
- 冠状动脉旁路移植 (CABG) 后新出现的术后心房动 (POAF) 是缺血性中风的已知危险因素.
- 然而,导致这种风险增加的具体因素以及当前风险评估工具在这个人群中的有效性仍然不清楚.
研究的目的:
- 为了确定与1年的缺血性中风风险相关的因素,在CABG后的POAF患者中.
- 为了比较CHA2DS2-VASc和ATRIA在这个队列中缺血性中风的预测准确度.
- 评估POAF患者在出院时使用口服抗凝剂 (OAC) 的模式.
主要方法:
- 全国范围的队列研究利用从瑞典国家登记处收集的前性数据 (2007-2020年).
- 包括首次隔离的CABG患者,他们发展了POAF.
- 多变量逻辑回归用于预测因素识别和C统计用于风险评分评估.
主要成果:
- 在10,435名POAF患者中,3.1%的非OAC患者在1年内经历了缺血性中风.
- 中风的独立预测因素包括年龄增长,先前的缺血性中风,心肌梗塞和心力衰竭.
- CHA2DS2-VASc和ATRIA得分显示出与非手术队列相似的预测准确性 (AUC分别为0.72和0.74).
- 值得注意的是,71.0%的患有计算中风风险>2%/年的患者没有在OAC上出院.
结论:
- 晚年,先前的缺血性中风,心力衰竭和心肌梗塞是POAF患者在CABG后的一年缺血性中风的重要危险因素.
- 在这个人群中,CHA2DS2-VASc和ATRIA得分有效预测中风风险.
- 目前的OAC出院实践可能与个体患者中风风险分层不充分一致.
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