Yong Hao Yeo, Aravinthan Vignarajah, Hermon Kha Kin Wong, Nishanthi Vigneswaramoorthy, Jian Liang Tan, Beeletsega T Yeneneh, Luis Scott, Komandoor Srivathsan, Justin Lee, Dan Sorajja
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Secondary outcomes included ischemic stroke and major bleeding events (intracranial bleeding/ gastrointestinal bleeding). Subanalyses were performed in the paroxysmal and persistent AF cohorts, respectively.</p><p><strong>Results: </strong>Among 342,230 eligible patients, 2,638 patients (mean age 64.3 ± 10.6 years) who underwent PVI and 2,638 patients (mean age 64.2 ± 13.1 years) who had AAD as first-line therapy for AF had similar propensity scores and were included in the analysis. At 5-year follow-up, the PVI group had a lower risk of the primary composite outcome compared to the AAD group (42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83; P < 0.01). They also had lower risk of all-cause mortality (4.1% vs. 7.7%; HR 0.53; 95% CI, 0.42-0.67; P < 0.01), all-cause hospitalization (35.1% vs. 42.2%; HR 0.77; 95% CI, 0.71-0.84; P < 0.01), and heart failure exacerbation (21.0% vs. 24.3%; HR 0.85; 95% CI, 0.76-0.95; P < 0.01. Ischemic stroke (6.1% vs. 6.7%; HR 0.90; 95% CI, 0.73-1.12; P = 0.34), and major bleeding event (4.3% vs. 5.3%; HR 0.80; 95% CI, 0.62-1.02; P = 0.08) were similar between groups. 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At 5-year follow-up, the PVI group had a lower risk of the primary composite outcome compared to the AAD group (42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83; P < 0.01). They also had lower risk of all-cause mortality (4.1% vs. 7.7%; HR 0.53; 95% CI, 0.42-0.67; P < 0.01), all-cause hospitalization (35.1% vs. 42.2%; HR 0.77; 95% CI, 0.71-0.84; P < 0.01), and heart failure exacerbation (21.0% vs. 24.3%; HR 0.85; 95% CI, 0.76-0.95; P < 0.01. Ischemic stroke (6.1% vs. 6.7%; HR 0.90; 95% CI, 0.73-1.12; P = 0.34), and major bleeding event (4.3% vs. 5.3%; HR 0.80; 95% CI, 0.62-1.02; P = 0.08) were similar between groups. 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引用次数: 0
摘要
背景：肺静脉隔离（PVI）在控制心房颤动（AF）的心律方面越来越被证明优于抗心律失常药物（AAD）。然而，比较这两种疗法作为一线房颤治疗的大规模、长期、真实世界的研究仍然有限。方法：使用TriNetX网络，我们确定了2012年至2019年期间患有房颤的患者（≥18岁）。患者被分为两组：作为房颤一线治疗的PVI组和AAD组。患者随访5年，主要结局为全因死亡、全因住院和心力衰竭加重。次要结局包括缺血性卒中和主要出血事件（颅内出血/胃肠道出血）。分别对阵发性和持续性房颤组进行亚组分析。结果：在342,230例符合条件的患者中，2,638例（平均年龄64.3±10.6岁）接受PVI治疗的患者和2,638例（平均年龄64.2±13.1岁）接受AAD作为AF一线治疗的患者具有相似的倾向评分，并被纳入分析。在5年随访中，PVI组与AAD组相比，主要复合结局的风险较低（42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83； P）结论：经过5年随访，PVI作为房颤一线治疗的临床结局优于AAD。
Clinical outcomes of pulmonary vein isolation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: a propensity score-matched analysis.
Background: Pulmonary vein isolation (PVI) has increasingly demonstrated superiority over antiarrhythmic drugs (AAD) for rhythm control in atrial fibrillation (AF). However, large-scale, long-term, real-world studies comparing these two therapies as first-line AF management remain limited.
Methods: Using the TriNetX network, we identified patients (≥ 18 years old) with AF between 2012 and 2019. Patients were categorized into two cohorts: PVI vs. AAD as first-line therapy for AF. Patients were followed for 5 years, with the primary outcome being a composite of all-cause death, all-cause hospitalization, and heart failure exacerbation. Secondary outcomes included ischemic stroke and major bleeding events (intracranial bleeding/ gastrointestinal bleeding). Subanalyses were performed in the paroxysmal and persistent AF cohorts, respectively.
Results: Among 342,230 eligible patients, 2,638 patients (mean age 64.3 ± 10.6 years) who underwent PVI and 2,638 patients (mean age 64.2 ± 13.1 years) who had AAD as first-line therapy for AF had similar propensity scores and were included in the analysis. At 5-year follow-up, the PVI group had a lower risk of the primary composite outcome compared to the AAD group (42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83; P < 0.01). They also had lower risk of all-cause mortality (4.1% vs. 7.7%; HR 0.53; 95% CI, 0.42-0.67; P < 0.01), all-cause hospitalization (35.1% vs. 42.2%; HR 0.77; 95% CI, 0.71-0.84; P < 0.01), and heart failure exacerbation (21.0% vs. 24.3%; HR 0.85; 95% CI, 0.76-0.95; P < 0.01. Ischemic stroke (6.1% vs. 6.7%; HR 0.90; 95% CI, 0.73-1.12; P = 0.34), and major bleeding event (4.3% vs. 5.3%; HR 0.80; 95% CI, 0.62-1.02; P = 0.08) were similar between groups. Similar outcomes were seen in both the paroxysmal and persistent AF cohorts.
Conclusion: After a 5-year follow-up period, PVI was associated with better clinical outcomes than AAD as first-line therapy for AF.
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