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Risk factors and prognoses analysis of new-onset atrial fibrillation in patients with acute myocardial infarction



Risk factors and prognoses analysis of new-onset atrial fibrillation in patients with acute myocardial infarction



Zhonghua Nei Ke Za Zhi 58(2): 133-138



目的: 探讨急性心肌梗死(AMI)患者新发心房颤动(NOAF)的危险因素及预后。 方法: 前瞻性纳入首都医科大学附属北京安贞医院接受急诊经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死患者468例。按照住院期间是否发生NOAF分为NOAF组37例和非NOAF组431例。比较两组患者的一般临床情况、冠状动脉病变情况、超声心动图、生化指标、C反应蛋白(CRP)、N末端B型利钠肽前体(NT-pro-BNP)、心肌标志物及院内死亡、院内主要心脑血管不良事件(MACCE)。并将可能的相关因素进行logistic多因素回归分析。 结果: 接受急诊PCI的AMI患者中NOAF发病率为7.9%。两组患者在进门-球囊扩张时间、体重、血小板计数、入院血肌酐(SCr)、术后SCr、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、尿酸、糖化血红蛋白、术前用药、病变支数、血栓抽吸、心肌梗死部位、高血压、糖尿病、外周血管病、陈旧性心肌梗死等方面差异无统计学意义,具有可比性。女性所占比例NOAF组高于非NOAF组(32.4%比16.7%,P<0.05),NOAF组年龄显著高于非NOAF组[(66±10)岁比(57±11)岁,P<0.001]。NOAF组患者无复流比例(40.5%比12.6%,P<0.001)、CRP[25.2(15.43,29.97)mg/L比5.21(2.33,16.98)mg/L,P<0.001]、白细胞计数[(11.19±3.44)×10(9)比(9.91±3.23)×10(9),P=0.022]、NT-pro-BNP[(652.6±108.8)ng/L比(258.3±105.9)ng/L,P<0.001]、肌钙蛋白I(TnI)[20.41(1.78,87.89)μg/L比7.72(1.29,36.39)μg/L,P=0.006]等显著高于非NOAF组患者。而左心室射血分数[(47.70±7.34)%比(53.35±8.05)%,P<0.001]、血红蛋白[137.0(125.5,146.0)g/L比144.0(133.0,156.0)g/L,P=0.042]明显低于非NOAF组患者。NOAF组患者住院时间明显长于非NOAF组患者[(8.7±5.6)d比(6.0±2.3)d,P=0.007]、院内死亡(8.1%比1.4%,P=0.004)及院内MACCE(37.8%比7.7%,P<0.001)显著高于非NOAF组患者。Logistic多因素回归分析显示,年龄(HR 1.083,95% CI 1.028~1.141,P=0.003)、CRP(HR 1.116,95% CI 1.049~1.187,P=0.001)、NT-pro-BNP(HR 1.463,95%CI 1.001~4.064,P=0.001)及无复流(HR4.388,95%CI 1.006~19.144,P=0.049)是AMI后NOAF的独立预测因素。 结论: 高龄、CRP、NT-pro-BNP水平升高以及无复流的出现预示AMI患者院内发生NOAF的风险可能增加。.

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Accession: 066446320

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PMID: 30704200


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