ПРОГНОЗ У ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ БЕЗ ПОДЪЕМА СЕГМЕНТА ST И ОСТРОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ
Аннотация
Цель исследования: оценка госпитального и отдаленного (12 месяцев) прогноза у пациентов с острым коронарным синдромом без подъема ST (ОКСБПST) на фоне эпизода острой фибрилляции предсердий (ФП). В исследование включено 236 пациентов в возрасте 61 [56; 68] лет, 127 мужчин и 109 женщин, госпитализированных с нестабильной стенокардией или острым инфарктом миокарда (ИМ) без подъема ST за период сентябрь-февраль 2016 г. Больные разделены на 2 группы в зависимости от наличия эпизода острой ФП в момент поступления: 1 группа 77 человек - ОКСБПST с острой ФП, 2 группа 159 человек - ОКСБПST без ФП. Пациентам с острой ФП синусный ритм (СР) восстанавливался электрической кардиоверсией (ЭКВ). Анализировали клинико-анамнестические данные. Значимый коронарный атеросклероз подтверждался данными коронарной ангиографии (КАГ). Были проанализированы госпитальная летальность, частота реваскуляризации миокарда в остром и отдаленном периодах, а также смертность, развитие инфаркта миокарда, ишемического инсульта, жизнеугрожающих кровотечений за 12 месяцев наблюдения. Острый ИМ без подъема ST реже диагностировался у пациентов с ФП. Значимый коронарный атеросклероз выявлялся реже у пациентов с ОКСБПST на фоне острой ФП как при нестабильной стенокардии, так и при остром ИМ. Реваскуляризация миокарда как в остром периоде, так и в течение 12 месяцев наблюдения, реже проводилась пациентам с ОКСБПST и ФП. Прогностические показатели (госпитальная летальность, смертность за 12 месяцев наблюдения и частота развития инфаркта миокарда) в группах пациентов с ФП и без ФП оказались сопоставимы, несмотря на то, что соответствующая рекомендациям антитромботическая терапия в группе с ФП назначалась значительно реже.
Литература
1. Скокова Е.Л., Заборских Н.И., Цыпленкова Е.А., Чичерина Е.Н. Актуальность проблемы хронической болезни почек в практике врача терапевта. // Вятский медицинский вестник. – 2011. - №1. – С. 12-17.
2. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. // European Heart Journal. – 2016. – Vol. 37. – P. 2893–2962.
3. Al khdair D., Alshengeiti L., Elbarouni B., et al. Management and outcome of acute coronary syndrome patients in relation to prior history of atrial fibrillation. // Can J Cardiol. – 2012. – Vol. 28. – P. 443-449.
4. Alonso A., Lopez F.L., Matsushita K. Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. // Circulation. – 2011. – Vol. 123(25). – P. 2946-2953.
5. Asanin M., Perunicic J., Mrdovic I., et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. // Eur J Heart Fail. – 2005. – Vol. 7. – P. 671-676.
6. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, International Edition, 10th Edition. Mann D., Zipes D., Libby P., Bonow R. – Elsevier Science, 2014. – 2040 p.
7. Cannon C.P., Weintraub W.S., Demopoulus L.A., et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with glycoprotein IIb/IIIa inhibitor tirofiban. // N Eng J Med. – 2001. – Vol. 344. – P. 1879-1887.
8. Conti A., Mariannini Y., Viviani G., et al. Abnormal troponin level as short-term predictor of poor outcome in acute atrial fibrillation. // Am J Emerg Med. – 2014. – Vol. 31. – P. 699-704.
9. Eldar M., Canetti M., Rotstein Z., et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. // Circulation. – 1998. – Vol. 97. – P. 965-970.
10. Erez A., Goldberger I., Sabbag A., et al. Temporal trends and outcomes associated with atrial fibrillation observed during acute coronary syndrome: Real-world data from the Acute Coronary Syndrome Israeli Survey (ACSIS), 2000-2013. // Clin Cardiol. – 2016. – DOI: 10.1002/clc.22654
11. Galvao Braga C., Ramos V., Martins J., et al. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. // Rev Port Cardiol. – 2015. – Vol. 34. – P. 403-410.
12. Galvao Braga C., Ramos V., Vieira C., et al. New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis. // Rev Port Cardiol. – 2014. – Vol. 33. – P. 281-287.
13. Gonzales-Pacheco H., Marquez M.F., Arias-Mendoza A., et al. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. // J Cardiol. – 2015. – Vol. 66. – P. 148-154.
14. Kinjo K., Sato H., Ohnishi Y., et al. Osaka Acute Coronary Insufficiency Study (OACIS) Group. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. // Am J Cardiol. – 2003. – Vol. 92. – P. 1150-1154.
15. Lau D.H., Huynh L.T., Chew D.P., et al. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. // Am J Cardiol. – 2009. – Vol. 104. – P. 1317-1323.
16. Lippi G., Picanza A., Formentini A., et al. The concentration of troponin I is increased in patients with acute-onset atrial fibrillation. // Int J Cardiol. – 2014. – Vol. 173. – P. 579–580.
17. Lopes R.D., Pieper K.S., Horton J.R., et al. 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.
18. Mehta R.H., Dabbous O.H., Granger C.B., et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. // Am J Cardiol. – 2003. – Vol. 92. – P. 1031-1036.
19. Schmitt J., Duray G., Gersh B.J., et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. // Eur Heart J. – 2009. – Vol. 30. – P. 1038–1045.
20. Schnabel R.B., Yin X., Gona P., et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. // Lancet. – 2015. – Vol. 386. – P. 154–162.
REFERENCES
1. Skokova Ye.L., Zaborskikh N.I., Tsyplenkova Ye.A., Chicherina Ye.N. Actuality of the problem of chronic kidney disease in physician’s practice // Vjatskij medicinskij vestnik. – 2011. – Vol. 29. №1. – P.12-17. (in Russian)
2. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. // European Heart Journal. – 2016. – Vol. 37. – P. 2893–2962.
3. Al khdair D., Alshengeiti L., Elbarouni B., et al. Management and outcome of acute coronary syndrome patients in relation to prior history of atrial fibrillation. // Can J Cardiol. – 2012. – Vol. 28. – P. 443-449.
4. Alonso A., Lopez F.L., Matsushita K. Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. // Circulation. – 2011. – Vol. 123(25). – P. 2946-2953.
5. Asanin M., Perunicic J., Mrdovic I., et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. // Eur J Heart Fail. – 2005. – Vol. 7. – P. 671-676.
6. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, International Edition, 10th Edition. Mann D., Zipes D., Libby P., Bonow R. – Elsevier Science, 2014. – 2040 p.
7. Cannon C.P., Weintraub W.S., Demopoulus L.A., et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with glycoprotein IIb/IIIa inhibitor tirofiban. // N Eng J Med. – 2001. – Vol. 344. – P. 1879-1887.
8. Conti A., Mariannini Y., Viviani G., et al. Abnormal troponin level as short-term predictor of poor outcome in acute atrial fibrillation. // Am J Emerg Med. – 2014. – Vol. 31. – P. 699-704.
9. Eldar M., Canetti M., Rotstein Z., et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. // Circulation. – 1998. – Vol. 97. – P. 965-970.
10. Erez A., Goldberger I., Sabbag A., et al. Temporal trends and outcomes associated with atrial fibrillation observed during acute coronary syndrome: Real-world data from the Acute Coronary Syndrome Israeli Survey (ACSIS), 2000-2013. // Clin Cardiol. – 2016. – DOI: 10.1002/clc.22654
11. Galvao Braga C., Ramos V., Martins J., et al. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. // Rev Port Cardiol. – 2015. – Vol. 34. – P. 403-410.
12. Galvao Braga C., Ramos V., Vieira C., et al. New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis. // Rev Port Cardiol. – 2014. – Vol. 33. – P. 281-287.
13. Gonzales-Pacheco H., Marquez M.F., Arias-Mendoza A., et al. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. // J Cardiol. – 2015. – Vol. 66. – P. 148-154.
14. Kinjo K., Sato H., Ohnishi Y., et al. Osaka Acute Coronary Insufficiency Study (OACIS) Group. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. // Am J Cardiol. – 2003. – Vol. 92. – P. 1150-1154.
15. Lau D.H., Huynh L.T., Chew D.P., et al. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. // Am J Cardiol. – 2009. – Vol. 104. – P. 1317-1323.
16. Lippi G., Picanza A., Formentini A., et al. The concentration of troponin I is increased in patients with acute-onset atrial fibrillation. // Int J Cardiol. – 2014. – Vol. 173. – P. 579–580.
17. Lopes R.D., Pieper K.S., Horton J.R., et al. 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.
18. Mehta R.H., Dabbous O.H., Granger C.B., et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. // Am J Cardiol. – 2003. – Vol. 92. – P. 1031-1036.
19. Schmitt J., Duray G., Gersh B.J., et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. // Eur Heart J. – 2009. – Vol. 30. – P. 1038–1045.
20. Schnabel R.B., Yin X., Gona P., et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. // Lancet. – 2015. – Vol. 386. – P. 154–162.
2. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. // European Heart Journal. – 2016. – Vol. 37. – P. 2893–2962.
3. Al khdair D., Alshengeiti L., Elbarouni B., et al. Management and outcome of acute coronary syndrome patients in relation to prior history of atrial fibrillation. // Can J Cardiol. – 2012. – Vol. 28. – P. 443-449.
4. Alonso A., Lopez F.L., Matsushita K. Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. // Circulation. – 2011. – Vol. 123(25). – P. 2946-2953.
5. Asanin M., Perunicic J., Mrdovic I., et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. // Eur J Heart Fail. – 2005. – Vol. 7. – P. 671-676.
6. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, International Edition, 10th Edition. Mann D., Zipes D., Libby P., Bonow R. – Elsevier Science, 2014. – 2040 p.
7. Cannon C.P., Weintraub W.S., Demopoulus L.A., et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with glycoprotein IIb/IIIa inhibitor tirofiban. // N Eng J Med. – 2001. – Vol. 344. – P. 1879-1887.
8. Conti A., Mariannini Y., Viviani G., et al. Abnormal troponin level as short-term predictor of poor outcome in acute atrial fibrillation. // Am J Emerg Med. – 2014. – Vol. 31. – P. 699-704.
9. Eldar M., Canetti M., Rotstein Z., et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. // Circulation. – 1998. – Vol. 97. – P. 965-970.
10. Erez A., Goldberger I., Sabbag A., et al. Temporal trends and outcomes associated with atrial fibrillation observed during acute coronary syndrome: Real-world data from the Acute Coronary Syndrome Israeli Survey (ACSIS), 2000-2013. // Clin Cardiol. – 2016. – DOI: 10.1002/clc.22654
11. Galvao Braga C., Ramos V., Martins J., et al. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. // Rev Port Cardiol. – 2015. – Vol. 34. – P. 403-410.
12. Galvao Braga C., Ramos V., Vieira C., et al. New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis. // Rev Port Cardiol. – 2014. – Vol. 33. – P. 281-287.
13. Gonzales-Pacheco H., Marquez M.F., Arias-Mendoza A., et al. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. // J Cardiol. – 2015. – Vol. 66. – P. 148-154.
14. Kinjo K., Sato H., Ohnishi Y., et al. Osaka Acute Coronary Insufficiency Study (OACIS) Group. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. // Am J Cardiol. – 2003. – Vol. 92. – P. 1150-1154.
15. Lau D.H., Huynh L.T., Chew D.P., et al. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. // Am J Cardiol. – 2009. – Vol. 104. – P. 1317-1323.
16. Lippi G., Picanza A., Formentini A., et al. The concentration of troponin I is increased in patients with acute-onset atrial fibrillation. // Int J Cardiol. – 2014. – Vol. 173. – P. 579–580.
17. Lopes R.D., Pieper K.S., Horton J.R., et al. 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.
18. Mehta R.H., Dabbous O.H., Granger C.B., et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. // Am J Cardiol. – 2003. – Vol. 92. – P. 1031-1036.
19. Schmitt J., Duray G., Gersh B.J., et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. // Eur Heart J. – 2009. – Vol. 30. – P. 1038–1045.
20. Schnabel R.B., Yin X., Gona P., et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. // Lancet. – 2015. – Vol. 386. – P. 154–162.
REFERENCES
1. Skokova Ye.L., Zaborskikh N.I., Tsyplenkova Ye.A., Chicherina Ye.N. Actuality of the problem of chronic kidney disease in physician’s practice // Vjatskij medicinskij vestnik. – 2011. – Vol. 29. №1. – P.12-17. (in Russian)
2. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. // European Heart Journal. – 2016. – Vol. 37. – P. 2893–2962.
3. Al khdair D., Alshengeiti L., Elbarouni B., et al. Management and outcome of acute coronary syndrome patients in relation to prior history of atrial fibrillation. // Can J Cardiol. – 2012. – Vol. 28. – P. 443-449.
4. Alonso A., Lopez F.L., Matsushita K. Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. // Circulation. – 2011. – Vol. 123(25). – P. 2946-2953.
5. Asanin M., Perunicic J., Mrdovic I., et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. // Eur J Heart Fail. – 2005. – Vol. 7. – P. 671-676.
6. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, International Edition, 10th Edition. Mann D., Zipes D., Libby P., Bonow R. – Elsevier Science, 2014. – 2040 p.
7. Cannon C.P., Weintraub W.S., Demopoulus L.A., et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with glycoprotein IIb/IIIa inhibitor tirofiban. // N Eng J Med. – 2001. – Vol. 344. – P. 1879-1887.
8. Conti A., Mariannini Y., Viviani G., et al. Abnormal troponin level as short-term predictor of poor outcome in acute atrial fibrillation. // Am J Emerg Med. – 2014. – Vol. 31. – P. 699-704.
9. Eldar M., Canetti M., Rotstein Z., et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. // Circulation. – 1998. – Vol. 97. – P. 965-970.
10. Erez A., Goldberger I., Sabbag A., et al. Temporal trends and outcomes associated with atrial fibrillation observed during acute coronary syndrome: Real-world data from the Acute Coronary Syndrome Israeli Survey (ACSIS), 2000-2013. // Clin Cardiol. – 2016. – DOI: 10.1002/clc.22654
11. Galvao Braga C., Ramos V., Martins J., et al. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. // Rev Port Cardiol. – 2015. – Vol. 34. – P. 403-410.
12. Galvao Braga C., Ramos V., Vieira C., et al. New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis. // Rev Port Cardiol. – 2014. – Vol. 33. – P. 281-287.
13. Gonzales-Pacheco H., Marquez M.F., Arias-Mendoza A., et al. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. // J Cardiol. – 2015. – Vol. 66. – P. 148-154.
14. Kinjo K., Sato H., Ohnishi Y., et al. Osaka Acute Coronary Insufficiency Study (OACIS) Group. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. // Am J Cardiol. – 2003. – Vol. 92. – P. 1150-1154.
15. Lau D.H., Huynh L.T., Chew D.P., et al. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. // Am J Cardiol. – 2009. – Vol. 104. – P. 1317-1323.
16. Lippi G., Picanza A., Formentini A., et al. The concentration of troponin I is increased in patients with acute-onset atrial fibrillation. // Int J Cardiol. – 2014. – Vol. 173. – P. 579–580.
17. Lopes R.D., Pieper K.S., Horton J.R., et al. 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.
18. Mehta R.H., Dabbous O.H., Granger C.B., et al. Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. // Am J Cardiol. – 2003. – Vol. 92. – P. 1031-1036.
19. Schmitt J., Duray G., Gersh B.J., et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. // Eur Heart J. – 2009. – Vol. 30. – P. 1038–1045.
20. Schnabel R.B., Yin X., Gona P., et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. // Lancet. – 2015. – Vol. 386. – P. 154–162.
Опубликована
2018-03-26
Как цитировать
МЕТЕЛЕВ, Илья Сергеевич et al.
ПРОГНОЗ У ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ БЕЗ ПОДЪЕМА СЕГМЕНТА ST И ОСТРОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ.
Сибирский медицинский журнал (Иркутск) 16+, [S.l.], v. 147, n. 8, p. 26-30, март 2018.
ISSN 1815-7572. Доступно на: <http://smj.ismu.baikal.ru/index.php/osn/article/view/73>. Дата доступа: 25 янв. 2025
Выпуск
Раздел
Оригинальные исследования
