2021 年第 12 期 第 16 卷

血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂对冠心病合并非瓣膜性心房颤动患者临床结局的影响

Impact of angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker on the clinical outcomes in patients with coronary atherosclerotic heart disease and nonvalvular atrial fibrillation

作者：乔岩王悦李松南蒋晨曦桑才华汤日波龙德勇吴嘉慧何柳杜昕董建增马长生

英文作者：Qiao Yan Wang Yue Li Songnan Jiang Chenxi Sang Caihua Tang Ribo Long Deyong Wu Jiahui He Liu Du Xin Dong Jianzeng Ma Changsheng

单位：首都医科大学附属北京安贞医院心内科国家心血管疾病临床医学研究中心100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University National Clinical Research Center for Cardiovascular Diseases Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；非瓣膜性心房颤动；血管紧张素转换酶抑制剂；血管紧张素Ⅱ受体拮抗剂

英文关键词：Coronaryatheroscleroticheartdisease;Nonvalvularatrialfibrillation;Angiotensinconvertingenzymeinhibitor；AngiotensinⅡreceptorblocker

• 摘要：

• 目的 探讨血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂（ACEI/ARB）对冠心病（冠状动脉粥样硬化性心脏病）合并非瓣膜性心房颤动（NVAF）患者临床结局的影响。方法 本研究从中国心房颤动注册研究中入选冠心病合并NVAF患者2 783例，根据是否应用ACEI/ARB分为ACEI/ARB组（1 362例）和未用ACEI/ARB组（1 421例）。主要终点事件是心血管死亡，次要终点事件是全因死亡、血栓栓塞事件和心血管原因住院。比较2组临床基线资料，分析ACEI/ARB对患者临床结局的影响。结果  ACEI/ARB组年龄75岁以上比例，合并高血压病、糖尿病、心力衰竭/左心室功能障碍比例，CHA2DS2-VASc评分≥2分比例和HAS-BLED积分≥3分比例均高于未用ACEI/ARB组，口服抗凝药物使用比例低于未用ACEI/ARB组（均P＜0.05）。患者随访2.99（1.48，4.90）年，Kaplan-Meier分析及单因素Cox回归分析结果显示，2组的主要终点事件和次要终点事件发生风险差异均无统计学意义（均P＞0.05）；但多因素Cox回归分析结果显示，ACEI/ARB明显降低冠心病合并NVAF患者的血栓栓塞事件风险（风险比=0.73，95%置信区间：0.56～0.95，P=0.021），而2组的全因死亡、心血管死亡和心血管原因住院风险差异均无统计学意义（均P＞0.05）。结论  ACEI/ARB治疗虽然没有明显降低冠心病合并NVAF患者的心血管死亡、全因死亡和心血管原因住院的风险，但明显降低了血栓栓塞事件的风险。

• Objective To investigate impact of angiotensin converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blocker (ARB) on the clinical outcomes in patients with coronary atherosclerotic heart disease (CHD) and nonvalvular atrial fibrillation (NVAF). Methods Totally 2 783 patients with CHD and NVAF were included in this study from the Chinese atrial fibrillation registration study. They were divided into ACEI/ARB group (1 362 cases) and unused ACEI/ARB group (1 421 cases) according to whether ACEI/ARB were applied. The primary endpoint was cardiovascular death, and the secondary endpoint was all-cause death, thromboembolic event and cardiovascular hospitalization. The clinical baseline data of the two groups were compared, and the impact of ACEI/ARB on clinical outcomes was analyzed. Results The rates of age over 75 years old, hypertension, diabetes mellitus, heart failure/left ventricular dysfunction, CHA2DS2-VASc score≥2 and HAS-BLED score≥3 in ACEI/ARB group were higher than those in unused ACEI/ARB group, and the rate of using oral anticoagulants in ACEI/ARB group was lower than that in unused ACEI/ARB group (all P＜0.05). The patients were followed-up for 2.99 (1.48, 4.90) years. Kaplan-Meier analysis and univariate Cox regression analysis showed that there were no significant differences in the risk of primary endpoint and secondary endpoint between the two groups (all P＞0.05). However, multivariate Cox regression analysis showed that ACEI/ARB significantly reduced the risk of thromboembolic events in patients with CHD and NVAF (hazard ratio=0.73, 95% confidence interval: 0.56-0.95, P=0.021), while there were no significant differences in the risk of all-cause death, cardiovascular death and cardiovascular hospitalization between the two groups (all P＞0.05). Conclusion  ACEI/ARB significantly decreased the risk of thromboembolic events in  patients with CHD and NVAF although there was no significant reduction in all-cause death, cardiovascular death and cardiovascular hospitalization.