在患有末期或慢性病的患者中,对心房的早期节律控制
Dong-Seon Kang1, Daehoon Kim2, Eunsun Jang2
1Department of Cardiology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
Mayo Clinic proceedings
|March 9, 2025
概括
患有慢性病 (CKD) 的心房动 (AF) 患者的早期节律控制 (ERC) 在CKD 3-4阶段显示出好处,但不是末期病 (ESKD). 考虑到功能,定制的AF治疗策略至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在慢性病 (CKD) 患者中,心房动 (AF) 是常见的.
- 早期节律控制 (ERC) 旨在维持AF患者的鼻节律.
- 在慢性病患者,特别是末期病患者 (ESKD) 中,ERC的风险-益处概况尚未明确.
研究的目的:
- 研究早期节律控制 (ERC) 与心房 (AF) 和慢性病 (CKD) 的不同阶段患者的节律控制的益处和风险.
- 在CKD和ESKD人群中比较ERC和速率控制策略之间的心血管结果和安全事件.
主要方法:
- 一项基于人口的队列研究包括5224名AF患者 (平均年龄70岁) 患有ESKD (n=1660) 和CKD阶段3-4 (n=3564).
- 患者在2005年至2015年期间接受了ERC或速率控制.
- 主要结局包括心血管死亡,缺血性中风,心力衰竭住院治疗和急性心肌梗塞.
主要成果:
- 在CKD3-4期患者中,ERC与初级结局的风险降低有关,而没有增加安全风险.
- 在ESKD患者中,ERC在初级结果中没有显著差异,但与复合安全结果的增加有关.
- 对ERC的坚持不佳,ESKD的65.0%和CKD阶段3-4的57.3%的患者在随访期间未能保持ERC.
结论:
- 早期节律控制在ESKD患者中具有适度的风险-益处概况,与CKD 3-4期患者相比.
- 对ERC的不良遵守会对其有效性产生重大影响,特别是在ESKD.
- 根据患者的功能,AF治疗策略应该是个性化的.
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