Прогностическое значение мерцательной аритмии у больных после перенесенного острого коронарного синдрома
Мерцательная аритмия
Дата публикации: декабря 19, 2014
Ключевые слова
острый коронарный синдром
мерцательная аритмия
прогноз
мерцательная аритмия
прогноз
Как цитировать
Донецкая О., Осмоловская В., Бакланова Т., Резниченко Н., Евдокимова М., Красильникова Е., Данковцева Е., Глезер М., Терещенко С., Сидоренко Б., Затейщиков Д. Прогностическое значение мерцательной аритмии у больных после перенесенного острого коронарного синдрома // Кремлевская медицина. Клинический вестник. 2014. Т. № 2. С. 11-19.
Аннотация
Для изучения вклада мерцательной аритмии (МА) при остром коронарном синдроме (ОКС) в долгосрочный про-гноз после стабилизации состояния обследовали 453 больных, проходивших лечение в стационарах Москвы с декабря2004 г. по июнь 2007 г. Учитывали развитие в течение периода наблюдения любого из следующих событий: фатальныйи нефатальный инфаркт миокарда (ИМ), нестабильная стенокардия, фатальный и нефатальный инсульт, смерть от дру-гих причин. Синусовый ритм зарегистрирован при поступлении и сохранялся в течение первых 10 дней у 419 (92,5%)больных, постоянная или персистирующая МА имела место на момент развития ОКС — у 16 (3,5%). У 18 (4,0%) боль-ных был зарегистрирован пароксизм МА. Средняя продолжительность жизни до конечной точки у больных с синусовымритмом составила 876,5 (±23,25) дня, у больных с постоянной или персистирующей формой МА — 817,3 (±123,30)дня, у больных с пароксизмом МА, развившимся в первые 10 дней ОКС — 549,9 (±113,81) дня (р=0,007). Относи-тельный риск наступления любой конечной точки у больного, перенесшего пароксизм МА, по сравнению с таковым убольного с синусовым ритмом составил 1,897 при 95% доверительном интервале (ДИ) от 1,214 до 2,963 (р=0,005).При многофакторном анализе независимыми предикторами неблагоприятного исхода (наступление фатального и не-фатального ИМ, фатального и нефатального инсульта, НС и смерти от других причин) после ОКС оказались только ИМ ванамнезе (OR=1,969, 95% CI 1,227–3,160, р=0,005), пароксизм МА, развившийся в 10 дней ОКС (OR=1,897, 95% CI1,214–2,963, р=0,005) и потребность в применении тиазидных диуретиков в период госпитализации (OR=1,936, 95%CI 1,153–3,249, р=0,012). Было выявлено, что при наличии 1 фактора риска развития неблагоприятного клиническогособытия по сравнению с их отсутствием риск составил 2,582 (95% CI 1,629–4,091, р<0,001), при наличии 2 факторов– 2,037 (95% CI 1,567–2,648, р<0,001). Таким образом, пароксизм МА, выявленный в течение первых 10 дней от раз-вития ОКС, ассоциируется с большей вероятностью развития неблагоприятных событий в течение ближайших 1—2 лет.Ключевые слова: острый коронарный синдром, мерцательная аритмия, прогноз.453 patients who were admitted in Moscow hospitals from December 2004 till June 2007 were examined so as to studythe importance of ciliary arrhythmia (CA) at acute coronary syndrome (ACS) for long-term prognosis after patients’ stabilization.The following events which occurred during the follow-up period were taken into consideration: fatal and non-fatalmyocardial infarction (MI), non-stable angina pectoris, fatal and non-fatal stroke, death due to other causes. 419 (92,5%)patients had sinus rhythm on admission and during the first 10 days; 16 (3,5%) patients had stable or persisting CA at ACSonset. 18 (4.0%) patients had CA paroxysm. Average survival period till the final point in patients with sinus rhythm was 876.5(±23.25) days; in patients with stable or persisting CA – 817.3 (±123.30) days; in patients with MA paroxysm which occurredduring the first 10 ACS days it was 549.9 (±113.81) days (р=0.007). A relative risk of approaching any final point inpatients who had CA paroxysm comparing to patients with sinus rhythm was 1.897 at 95% confidence interval (CI) from 1.214till 2.963 (р=0,005). While making a multifactor analysis it has been found out that independent predictors of unfavorableoutcome (fatal or nonfatal MI, fatal or non-fatal stroke, non-stable angina pectoris and death due to other causes) after ACSwere MI in anamnesis (OR=1.969; 95% CI 1.227–3.160; р=0.005), CA paroxysm which occurred during the first 10 ACSdays (OR=1.897; 95% CI 1.214–2.963; р=0.005) and the amount of tiazide diuretics prescribed in the hospital (OR=1.936;95% CI 1.153–3.249; р=0.012). It has been found out that if even one risk factor of unfavorable clinical event is present, therisk is 2.582 (95% CI 1.629–4.091; р<0.001) comparing to the absence of any risk factor; if two risk factors are present – therisk was 2.037 (95% CI 1.567–2.648; р<0.001). Thus, CA paroxysm revealed during the first 10 ACS days is associated withhigher risk of developing unfavorable events for the nearest 1–2 years.Key word: acute coronary syndrome, ciliary arrhythmia, prognosis.Литература
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Wolf J.E., Cottin Y. Atrial fibrillation during myocardial
infarction with and without ST segment elevation.
Arch Mal Coeur Vaiss, June 1. – 2005. – Vol. 98(6). – P. 608–614.
16. Behar S., Zahavi Z., Goldbourt U., Reicher-reiss H..
Long-term prognosis of patients with paroxysmal atrial fibrillation
complicating acute myocardial infarction. European Heart Journal.
– 1992. – Vol. 13(1). – P. 45–50.
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Velazquez E.J, Diaz R., Maggioni A.P., Mareev V., Opolski G., Van de
Werf F., Zannad F., Ertl G., Solomon S.D., Zelenkofske S., Rouleau
J.L., Leimberger J.D., Califf R.M. Previously known and newly
diagnosed atrial fibrillation: a major risk indicator after a myocardial
infarction complicated by heart failure or left ventricular dysfunction.
Eur J Heart Fail, October 1. – 2006. – Vol. 8(6). – P. 591–598.
fibrillation in the setting of acute myocardial infarction: the
GUSTO-I experience. Global Utilization of Streptokinase and TPA
for Occluded Coronary Arteries. J Am Coll Cardiol. – 1997. – Vol.
30. – P. 406–413.
2. Pizzetti F., Turazza F.M., Franzosi M.G. et al. Incidence
and prognostic significance of atrial fibrillation in acute myocardial
infarction: the GISSI-3 data. Heart – 2001. – Vol. 86. – P. 527–
532.
3. Wong C.K., White H.D., Wilcox R.G., Criger D.A., Califf
R.M., Topol E.J., Ohman E.M. Significance of atrial fibrillation
during acute myocardial infarction, and its current management:
insights from the GUSTO-3 trial. Card Electrophysiol Rev, September
1. – 2003. – Vol. 7(3). – P. 201–207.
4. Lehto M., Snapinn S., Dickstein K. et al. Prognostic risk of
atrial fibrillation in acute myocardial infarction complicated by left
ventricular dysfunction: the OPTIMAAL experience. Eur Heart J.
– 2005. – Vol. 26. – P. 350–356.
5. Goldberg R.J., Seeley D., Becker R.C., Brady P., Chen
Z.Y., Osganian V., Gore J.M., Alpert J.S., Dalen J.E. Impact of
atrial fibrillation on the in-hospital and long-term survival of patients
with acute myocardial infarction: a community-wide perspective. Am
Heart J, May 1. – 1990. – Vol. 119(5). – P. 996–1001.
6. Madias J.E., Patel D.C., Singh D. Atrial fibrillation in
acute myocardial infarction: a prospective study based on data from
a consecutive series of patients admitted to the coronary care unit.
Clin Cardiol, March 1. – 1996. – Vol. 19(3). – P. 180–186.
7. Serrano C.V., Ramires J.A., Mansur A.P. Pileggi F.
Importance of the time of onset of supraventricular tachyarrhythmias
on prognosis of patients with acute myocardial infarction. Clin
Cardiol, February 1. – 1995. – Vol. 18(2). – P. 84–90.
8. Шульман В.А., Шестерня П.А., Головенкин С.Е., Ра-
дионов В.В. Фибрилляция предсердий у больных инфарктом
миокарда:предикторы возникновения, влияние на ближайший
и отдаленный прогноз. Вестник аритмологии. – 2005. № 39.
– С. 5–9.
9. Chung-Wah S., Jim M., Ho H., Miu R., Lee S.W.L., Lau
C., Tse H. Transient Atrial Fibrillation Complicating Acute Inferior
Myocardial Infarction. Implications for Future Risk of Ischemic
Stroke. Chest. – 2007. – Vol. 132. – P. 44–49.
10. Lopes R.D., Pieper K.S., Horton J.R., Al-Khatib S.M.,
Newby L.K., Mehta R.H., Van de Werf F., Armstrong P.W., Mahaffey
K.W., Harrington R.A., Ohman E.M., White H.D., Wallentin
L., Granger C.B. Short- and long-term outcomes following atrial
fibrillation in patients with acute coronary syndromes with or without
ST-segment elevation. Heart. – 2008. – Vol. 94. – P. 867–873.
11. ACC/AHA/ESC 2006 Guidelines for the Management of
Patients With Atrial Fibrillation. A Report of the American College
of Cardiology/American Heart Association Task Force on Practice
Guidelines and the European Society of Cardiology Committee
for Practice Guidelines (Writing Committee to Revise the 2001
Guidelines for the Management of Patients With Atrial Fibrillation):
Developed in Collaboration With the European Heart Rhythm
Association and the Heart Rhythm Society. Circulation, Aug 2006;
114: e257 - e354.
12. Mehta R.H., Dabbous O.H., Granger C.B., Kuznetsova
P., Kline-Rogers E.M., Anderson F.A., Fox K.A.A., Gore J.M.,
Goldberg R.J., Eagle K.A. Comparison of Outcomes of Patients With
Acute Coronary Syndromes With and Without Atrial Fibrillation.
Am J Cardiol. – 2003. – Vol. 92. – P. 1031–1036.
13. Rathore S.S., Berger A.K., Weinfurt K.P., Schulman K.A.,
Oetgen W.J., Gersh B.J., Solomon A.J. Acute Myocardial Infarction
Complicated by Atrial Fibrillation in the Elderly. Circulation. –
2000. – Vol. 101. – P. 969.
14. Sakata K., Kurihara H., Iwamori K., Maki A., Yoshino
H., Yanagisawa A., Ishikawa K. Clinical and prognostic significance
of atrial fibrillation in acute myocardial infarction. Am J Cardiol,
December 15. – 1997. – Vol. 80(12). – P. 1522–1527.
15. Laurent G., Dentan G., Moreau D., Zeller M.,
Laurent Y., Vincent-Martin M., Lhuillier I., Makki H.,
Wolf J.E., Cottin Y. Atrial fibrillation during myocardial
infarction with and without ST segment elevation.
Arch Mal Coeur Vaiss, June 1. – 2005. – Vol. 98(6). – P. 608–614.
16. Behar S., Zahavi Z., Goldbourt U., Reicher-reiss H..
Long-term prognosis of patients with paroxysmal atrial fibrillation
complicating acute myocardial infarction. European Heart Journal.
– 1992. – Vol. 13(1). – P. 45–50.
17. Kober L., Swedberg K., McMurray J.J., Pfeffer M.A.,
Velazquez E.J, Diaz R., Maggioni A.P., Mareev V., Opolski G., Van de
Werf F., Zannad F., Ertl G., Solomon S.D., Zelenkofske S., Rouleau
J.L., Leimberger J.D., Califf R.M. Previously known and newly
diagnosed atrial fibrillation: a major risk indicator after a myocardial
infarction complicated by heart failure or left ventricular dysfunction.
Eur J Heart Fail, October 1. – 2006. – Vol. 8(6). – P. 591–598.