Supplementary Material for: The Effect of Atrial Fibrillation on the Long-Term Mortality of Patients with Acute Coronary Syndrome: The TACOS Study

Introduction: Atrial fibrillation (AF) is a frequent finding in acute coronary syndrome (ACS), but there is conflicting scientific evidence regarding its long-term impact on patient outcome. The aim of this study was to survey and compare the ≥10-year mortality of ACS patients with sinus rhythm (SR) and AF. Methods: Patients were divided into 2 groups based on rhythm in their 12-lead ECGs: (1) SR (n = 788) at hospital admission and discharge (including sinus bradycardia, physiological sinus arrhythmia, and sinus tachycardia) and (2) AF/atrial flutter (n = 245) at both hospital admission and discharge, or SR and AF combination. Patients who failed to match the inclusion criteria were excluded from the final analysis. The main outcome surveyed was long-term all-cause mortality between AF and SR groups during the whole follow-up time. Results: Consecutive ACS patients (n = 1,188, median age 73 years, male/female 58/42%) were included and followed up for ≥10 years. AF patients were older (median age 77 vs. 71 years, p < 0.001) and more often female than SR patients. AF patients more often presented with non-ST-elevation myocardial infarction (69.8 vs. 50.4%, p < 0.001), had a higher rate of diabetes (31.0 vs. 22.8%, p = 0.009), and were more often using warfarin (32.2 vs. 5.1%, p < 0.001) or diuretic medication (55.1 vs. 25.8%, p < 0.001) on admission than patients with SR. The use of warfarin at discharge was also more frequent in the AF group (55.5 vs. 14.8%, p < 0.001). The rates of all-cause and cardiovascular mortality were higher in the AF group (80.9 vs. 50.3%, p < 0.001, and 73.8 vs. 69.6%, p = 0.285, respectively). In multivariable analysis, AF was independently associated with higher mortality when compared to SR (adjusted HR 1.662; 95% CI: 1.387–1.992, p < 0.001). Conclusion: AF/atrial flutter at admission and/or discharge independently predicted poorer long-term outcome in ACS patients, with 66% higher mortality within the ≥10-year follow-up time when compared to patients with SR.

引言：心房颤动（Atrial fibrillation, AF）是急性冠状动脉综合征（acute coronary syndrome, ACS）的常见临床表现，但现有科学证据对其对患者远期预后的长期影响尚存争议。本研究旨在调查并对比窦性心律（sinus rhythm, SR）与心房颤动患者的≥10年全因死亡率。
方法：研究对象根据入院及出院时的12导联心电图（12-lead ECG）节律分为两组：(1) 窦性心律组（n = 788）：入院及出院时均为窦性心律（包括窦性心动过缓、生理性窦性心律不齐及窦性心动过速）；(2) 心房颤动/心房扑动组（n = 245）：入院及出院时均为心房颤动/心房扑动，或入院为窦性心律、出院为心房颤动。不符合纳入标准的患者被排除于最终分析之外。本研究的主要观察结局为全随访周期内，心房颤动组与窦性心律组的远期全因死亡率。
结果：本研究共纳入连续性急性冠状动脉综合征患者1188例，中位年龄73岁，男性占比58%、女性占比42%，随访时长≥10年。与窦性心律组相比，心房颤动患者年龄更大（中位年龄77岁 vs 71岁，p < 0.001），女性占比更高。心房颤动患者更常表现为非ST段抬高型心肌梗死（69.8% vs 50.4%，p < 0.001），糖尿病患病率更高（31.0% vs 22.8%，p = 0.009），入院时使用华法林（32.2% vs 5.1%，p < 0.001）或利尿剂（55.1% vs 25.8%，p < 0.001）的比例也显著高于窦性心律组。出院时华法林的使用比例在心房颤动组同样更高（55.5% vs 14.8%，p < 0.001）。心房颤动组的全因死亡率及心血管死亡率均更高（分别为80.9% vs 50.3%，p < 0.001；73.8% vs 69.6%，p = 0.285）。多变量分析显示，与窦性心律组相比，心房颤动与更高的死亡率独立相关（校正后风险比（hazard ratio, HR）1.662；95%置信区间（confidence interval, CI）：1.387–1.992，p < 0.001）。
结论：入院及/或出院时存在心房颤动/心房扑动，可独立预测急性冠状动脉综合征患者的远期不良预后，在≥10年的随访周期内，其死亡率较窦性心律患者升高66%。