摘要
目的术后心房颤动的发生被认为与心血管不良事件相关。文中探讨急性心肌梗死后心房颤动的发生与长期心血管不良事件的相关性。方法回顾性分析2014年1月至2017年5月在北京朝阳医院行急诊经皮冠状动脉介入治疗的483名急性ST段抬高型心肌梗死合并多支血管病变患者,并根据急性梗死后是否发生房颤分为房颤组(n=52)和非房颤组(n=431)。临床主要终点事件为长期心血管不良复合事件,包括心血管死亡和急性心衰发作或缺血性脑卒中入院;次要终点事件定义为30 d内心血管死亡。采用多因素logistic回归分析以及COX回归分析模型分析新发房颤与心血管死亡及不良事件的关系。结果相比于非房颤组,房颤组患者年龄更高[(62.2±12.6)岁vs(69.8±10.5)岁],总胆固醇[(4.6±1.1)mmol/L vs(4.0±0.9)mmol/L]、低密度脂蛋白胆固醇[(2.9±0.9)mmol/L vs(2.4±0.9)mmol/L]、射血分数更低[(59.2±11.3)vs(49.9±9.3)%],超敏C反应蛋白[5.2(2.2,11.0)mg/L vs 10.0(3.2,12.8)mg/L]、红细胞沉降率[7(4,15)mm/h vs 12(5.5,23.5)mm/h]、肌酐[75.8(64.5,88.0)μmol/L vs 96.5(69.3,143.1)μmol/L]、肌钙蛋白I[27.7(8.6,71.3)ng/mL vs 74.2(21.1,168.1)ng/mL]、SYNTAX积分以及GRACE积分均较高(P<0.05)。多因素logistic回归分析发现,新发房颤、年龄、超敏C反应蛋白、红细胞沉降率、入院肌酐水平、空腹血糖以及冠状动脉SYNTAX评分均为30 d心血管死亡的独立危险因素(P<0.05);而COX回归分析中发现新发房颤与长期心血管死亡、急性心衰发作和缺血性脑卒中发生的复合不良终点有关(HR=3.709,P<0.05)。新发心房颤动可提高GRACE评分预测临床预后效能,但差异无统计学意义(0.788 vs 0.767,P=0.08)。结论急性ST段抬高型心肌梗死合并多支血管病变患者急诊PCI术后新发心房颤动与30 d心血管死亡以及长期临床心血管不良事件有关。但新发房颤并不能增加GRACE评分预测价值。
Objective NeNewly onset atrial fibrillation(AF)is a common complication of acute myocardial infarction(AMI),which is considered to be related to cardiovascular adverse events.This paper aims to discuss the relationship between atrial fibrillation and long-term cardiovascular adverse events after acute myocardial infarction.Methods A retrospective analysis of 483 STEMI patients with multivessel disease,who underwent emergency percutaneous coronary intervention(PCI)in Beijing Chaoyang Hospital from January 2014 to May 2017,was conducted.Patients were divided into two groups:AF group:n=52(10.8%)and non-AF group:n=431(89.2%)according to including criteria.The primary endpoint event was long-term major adverse cardiovascular events,including cardiovascular death,acute heart failure or ischemia stroke.The secondary endpoint event was defined as 30-day cardiovascular death.Multivariate logistic regression analysis and Cox proportional hazards mode were performed to analyze the relationship between newly onset atrial fibrillation and cardiovascular adverse events,such as cardiovascular death.Results Compared with non-AF group,AF group had older age,higher levels of C-reactive protein,erythrocyte sedimentation rate,creatinine,troponin,SYNTAX score and GRACE score and lower levels of total cholesterol,low density lipoproteins and ejection fraction(P<0.01).In the multivariate logistic regression analysis model,newly onset atrial fibrillation,age,high-sensitivity C-reactive protein,erythrocyte sedimentation rate,admission creatinine level,fasting blood glucose,and coronary SYNTAX score were all independent risk factors associated with higher risks of 30-day cardiovascular death(OR=1.983,95%CI=1.036-3.795,P=0.04).Using Cox proportional hazards mode,newly onset atrial fibrillation following primary PCI was associated with long-term clinical adverse cardiovascular event(HR=1.983,95%CI=1.036-3.795,P=0.04)after adjusting all covariates.The area under the ROC curve for combined prediction mode with GRACE score and newly onset AF was comparable to the one for the model with GRACE score alone(0.788 vs 0.767,P=0.08).Conclusion Newly onset atrial fibrillation in STEMI patients with multivessel disease who underwent emergency PCI is associated with 30-day cardiovascular death and long-term clinical adverse cardiovascular events.However,newly onset atrial fibrillation does not increase the predictive value of GRACE score.
作者
王宇星
李闯
高元丰
王欣
王乐丰
杨新春
张大鹏
WANG Yu-xing;LI Chuang;GAO Yuan-feng;WANG Xin;WANG Le-feng;YANG Xin-chun;ZHANG Da-peng(Cardiology Department,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《医学研究生学报》
CAS
北大核心
2020年第7期741-747,共7页
Journal of Medical Postgraduates
基金
国家重点研发计划资助(2016YFC1301100)。
关键词
新发心房颤动
急性ST段抬高型心肌梗死
多支血管病变
长期心血管不良事件
newly onset atrial fibrillation
acute ST-segment myocardial infarction
multivessel disease
long-term major adverse cardiovascular event
