ミヤサカ　ヨウコ   MIYASAKA YOKO   宮坂　陽子    所属   関西医科大学  内科学第二講座    職種   准教授
論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	査読あり
表題	Coronary ischemic events after first atrial fibrillation: risk and survival.
掲載誌名	正式名：The American journal of medicine 略　 称：Am J Med ISSNコード：00029343/15557162
巻・号・頁	120(4),pp.357-363
著者・共著者	Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Seward JB, Iwasaka T, Tsang TS.
担当区分	筆頭著者
発行年月	2007/04
概要	PURPOSE: We aimed to determine the long-term, gender-specific incidence and mortality risk of coronary ischemic events after first atrial fibrillation (AF). METHODS: In this longitudinal cohort study, adult residents of Olmsted County, Minnesota, with an electrocardiogram-confirmed AF first documented in 1980 to 2000 and without prior coronary heart disease, were followed to 2004. The primary outcome was first coronary events (angina with angiographic confirmation, unstable angina, nonfatal myocardial infarction, or coronary death). Sex-specific incidence of coronary ischemic events and survival after development of such events were assessed using Cox proportional hazards modeling. Kaplan-Meier estimates of risks for coronary ischemic events were compared with those predicted by the Framingham equation. RESULTS: Of the 2768 subjects (mean age 71 years, 48% were men), 463 (17%) had a first coronary event during a follow-up of 6.0+/-5.2 years. The unadjusted incidence was 31 per 1000 person-years, and there was no difference between men and women. The incidence was higher in men (hazard ratio 1.32, P=.004) after adjusting for age. The 10-year event estimates were 22% and 19% in men and women, respectively, by our Kaplan-Meier analyses, and 21% and 11%, respectively, by Framingham risk equation. The mortality risk after coronary events was higher in women (hazard ratio 2.99 vs 2.33; P=.044), even after multiple adjustment. CONCLUSIONS: First AF marks a high risk for new coronary ischemic events in both men and women. AF conferred additional risk for coronary events beyond conventional risk prediction in women only. The excess mortality risk associated with the development of coronary events was significantly greater in women.
文献番号	17398231