Cancer:癌症可明显增加房颤患者的心血管死亡率!

2021-02-26 MedSci原创 MedSci原创

房颤+癌症,死亡率是多少呢?

在临床上,心房颤动(房颤,AF)合并癌症的患者数量正在迅速增加。癌症对房颤患者临床预后的影响尚不明确,对HAS‐BLED(高血压、肾/肝功能异常、卒中、出血史或易感性、不稳定INR、老年、药物/酒精)和CHA2DS2-VASc(充血性心力衰竭、高血压、≥75岁、糖尿病、卒中或短暂性脑缺血发作、血管疾病、65-74岁、性别)评分的影响也尚不明确。

本研究是一项观察性、回顾性的队列研究,纳入了243541名成人AF住院患者。研究人员根据有无癌症和癌症类型调查了这些患者的全因死亡率和心血管死亡率、缺血性卒中、大出血和颅内出血(ICH)的发病率(IR)。

总体上,399344人(16.4%)患有癌症,最常见的癌症是转移癌、前列腺癌、结直肠癌、肺癌、乳腺癌和膀胱癌。在平均2.0年的随访期间,癌症增加了患者的全因死亡率(危险比[HR],2.00;95%CI 1.99-2.01)。

房颤患者的癌症发生率

缺血性卒中的发病率在合并胰腺癌(2.8%/年)、子宫癌(2.6%/年)和乳腺癌(2.6%/年)的患者中较高,而肝癌/肺癌(1.9%/年)和白血病/骨髓瘤(2.0%/年)患者的缺血性卒中发病率反而低于非肿瘤患者(2.4%/年)。

有无癌症的AF患者的心血管死亡(左上)、缺血性卒中(右上)、大出血(左下)和颅内出血(右下)的累积发生率

此外,癌症还增加了大出血(HR 1.27;95%CI 1.26-1.28)和脑出血(1.07;1.05-1.10)的风险。白血病、肝癌、骨髓瘤和转移性癌症大出血/脑出血的发病率最高。大出血和脑出血的发生率随着HAS‐BLED评分的增加而递增,对所有类型癌症都具有较好的预测性(C指数>0.70)。CHA2DS2‐VASc评分在患有癌症的房颤患者中的预测性稍低。

总之,癌症增加了房颤患者的全因死亡率、大出血和脑出血风险。癌症和缺血性卒中之间的相关性因癌症类型而异,在某些类型中,出血的风险似乎超过了血栓栓塞的风险。

原始出处:

Pastori Daniele,Marang Amélie,Bisson Arnaud et al. Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: A nationwide cohort study. Cancer, 2021, 10.1002/cncr.33470

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    2021-02-26 心介

    房颤,临床上碰到很多哦

    0

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    2021-02-26 jyzxjiangqin

    好文章!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1418499, encodeId=2efd141849928, content=<a href='/topic/show?id=772e5182166' target=_blank style='color:#2F92EE;'>#心血管死亡率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51821, encryptionId=772e5182166, topicName=心血管死亡率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26613379061, createdName=smallant2003, createdTime=Sun Feb 28 07:46:52 CST 2021, time=2021-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1554222, encodeId=94ee155422206, content=<a href='/topic/show?id=ab025182080' target=_blank style='color:#2F92EE;'>#心血管死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51820, encryptionId=ab025182080, topicName=心血管死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0fb814514579, createdName=huperzia, createdTime=Sun Feb 28 07:46:52 CST 2021, time=2021-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614585, encodeId=f616161458534, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sun Feb 28 07:46:52 CST 2021, time=2021-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031354, encodeId=8e4b10313542e, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Fri Feb 26 19:46:52 CST 2021, time=2021-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943762, encodeId=a20d943e6241, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Feb 26 17:00:52 CST 2021, time=2021-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943740, encodeId=1650943e40f4, content=癌症增加了房颤患者的全因死亡率、大出血和脑出血风险。癌症和缺血性卒中之间的相关性因癌症类型而异,在某些类型中,出血的风险似乎超过了血栓栓塞的风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/02/7354b3539aae6a0ccb1e0fff04c12084.jpg, createdBy=205b1984786, createdName=随梦飞扬, createdTime=Fri Feb 26 16:51:21 CST 2021, time=2021-02-26, status=1, ipAttribution=)]
    2021-02-26 随梦飞扬

    癌症增加了房颤患者的全因死亡率、大出血和脑出血风险。癌症和缺血性卒中之间的相关性因癌症类型而异,在某些类型中,出血的风险似乎超过了血栓栓塞的风险。

    0

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