Influencing factors of all-cause mortality in elderly patients with non-valvular atrial fibrillation and acute coronary syndrome
Objective To analyze the mortality of elderly patients with non-valvular atrial fibrillation(NVAF)and acute coronary syndrome(ACS),and to discuss the influencing factors of all-cause mortality.Methods The clinical data of 1 369 elderly patients(aged≥65 years)with NVAF and ACS in Henan Provincial People's Hospital from January 2012 to December 2017 were retrospectively analyzed.All patients were given individualized comprehensive treatment plan.The follow-up lasted for 3 to 10 years to record the all-cause mortality.Totally 1 369 patients were divided into death and survival groups.The gender ratio,age,body mass index,smoking habits,type of NVAF(persistent,permanent,paroxysmal),comorbidities(hypertension,diabetes,heart failure,peripheral vascular disease,ischemic stroke,bleeding,gastrointestinal ulcers),and admission CHA2DS2-VASc score and HAS-BLED score were compared between two groups.The radiofrequency ablation,percutaneous coronary intervention(PCI),coronary artery bypass grafting(CABG),and the applications of antiarrhythmic,ventricular rate-controlling,anticoagulant,antiplatelet and antihyperlipidemic drugs in hospital were recorded in two groups.Multivariate Cox regression analysis was performed to assess the influencing factors of all-cause mortality in elderly patients with NVAF and ACS.Results(1)The follow-up lasted for(30.6±14.4)months till November 2020,all-cause mortality developed in 149 patients,and the other 1 220 patients survived.The patients were older in death group[79.0(73.0,84.0)years]than in survival group[75.0(70.0,81.0)years](U=-4.883,P＜0.001),the body mass index was smaller in death group[24.9(22.0,25.0)kg/m2]than that in survival group[25.0(23.2,26.0)kg/m2](U=3.025,P=0.003),the proportions of heart failure and bleeding,and admission HAS-BLED score were higher in death group[52.3％,4.7％,3.0(2.0,3.0)]than those in survival group[40.1％,2.0％,2.0(2.0,3.0)](P＜0.05),and there were no significant differences in the gender ratio,type of atrial fibrillation,smoking habits,proportions of comorbidities(diabetes,hypertension,peripheral vascular disease,ischemic stroke,gastrointestinal ulcers)and admission CHA2DS2-VASc score between two groups(P＞0.05).(2)The proportions of applying diuretics,digoxin,fondahexyl sodium and tirofiban were higher in death group(73.2％,42.3％,6.0％,4.0％)than those in survival group(56.3％,32.2％,2.3％,1.6％)(P＜0.05),the proportion of applying calcium channel blockers was lower in death group(21.5％)than that in survival group(31.1％)(P＜0.05),and there were no significant differences in the proportions of applying PCI,CABG,radiofrequency ablation,amiodarone,propafenone,β-receptor blockers,angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists,statins,nitrates,trimetazidine,proton pump inhibitors,low-molecular heparin,aspirin,clopidogrel,tegretol,warfarin and new oral anticoagulants between two groups(P＞0.05).(3)The old age(HR=1.058,95％CI:1.033-1.084,P＜0.001),bleeding(HR=2.517,95％CI:1.159-5.466,P=0.020),applying diuretics(HR=1.669,95％CI:1.116-2.497,P=0.013),and applying tirofiban(HR=3.022,95％CI:1.301-7.017,P=0.010)were the risk factor of all-cause mortality in elderly patients with NVAF and ACS,and body mass index of 24.0-＜28.0 kg/m2(HR=0.657,95％CI:0.460-0.937,P=0.021)was the protective factor of survival.Conclusion The risk of all-cause mortality increases in elderly patients with NVAF and ACS when they are old,have bleeding history and apply diuretics and tirofiban,and decreases in those with body mass index of 24.0-＜28.0 kg/m2.
NETL
NSTL
万方数据
维普
