The impact of digoxin on the long-term outcomes in patients with coronary artery disease and atrial fibrillation
10.3760/cma.j.cn112138-20201123-00967
- VernacularTitle:地高辛对冠心病合并心房颤动患者远期临床结果的影响
- Author:
Yan QIAO
1
;
Yue WANG
;
Chenxi JIANG
;
Songnan LI
;
Caihua SANG
;
Ribo TANG
;
Deyong LONG
;
Jiahui WU
;
Liu HE
;
Xin DU
;
Jianzeng DONG
;
Changsheng MA
Author Information
1. 国家心血管病临床医学研究中心 首都医科大学附属北京安贞医院心内科 100029
- Keywords:
Coronary artery disease;
Atrial fibrillation;
Digoxin;
Heart failure
- From:
Chinese Journal of Internal Medicine
2021;60(9):797-805
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the long-term safety of digoxin in patients with coronary artery disease (CAD) and atrial fibrillation (AF).Methods:This was a prospective study, in which 25 512 AF patients were enrolled from China Atrial Fibrillation Registry Study. After exclusion of patients receiving ablation therapy at the enrollment, 1 810 CAD patients [age: (71.5±9.3)years] with AF were included. The subjects were grouped into the digoxin group and non-digoxin group, and were followed up for a period of 80 months. Long-term outcomes were compared between the groups and an adjusted Cox regression analysis was applied to evaluate the risk of digoxin on the long-term outcomes. The primary endpoint was all-cause mortality.Results:The patients were followed up for a median period of 3.05 years. After multivariable adjustment, the Cox regression analysis showed that digoxin significantly increased the risk of all-cause mortality ( HR=1.28, 95% CI 1.01-1.61, P=0.038), cardiovascular mortality ( HR=1.48,95% CI 1.10-2.00, P=0.010), cardiovascular hospitalization ( HR=1.67,95% CI 1.35-2.07, P=0.008) and the composite endpoints ( HR=2.02,95% CI 1.71-2.38, P<0.001). In the subgroup of patients with heart failure (HF), digoxin was not associated with the risk of all-cause mortality, but was still associated with the increased risk of cardiovascular mortality ( HR=1.44,95% CI 1.05-1.98, P=0.025), cardiovascular hospitalization ( HR=1.44,95% CI 1.09-1.90, P=0.010) and the composite endpoints ( HR=1.37, 95% CI 1.01-1.70, P=0.004). However, in the subgroup of patients without HF, digoxin was only associated with all-cause mortality ( HR=2.56,95% CI 1.44-4.54, P=0.001). Conclusion:Digoxin significantly increased the risk of all-cause mortality in CAD patients with AF, especially in patients without HF.
