摘要
目的探讨急性心肌梗死患者急性期新发心房颤动(以下简称房颤)对患者预后的影响。方法回顾性分析2017年7月-2019年1月在上海市浦东新区公利医院住院并接受冠状动脉介入治疗的急性心肌梗死患者。根据急性期是否发作房颤分为房颤组(n=25)和非房颤组(n=168),比较两组的临床特征以及预后。随访终点为心血管不良事件,包括心源性死亡,再发非致死性心肌梗死,非计划性血运重建,因心肌缺血症状再次住院,缺血性脑卒中及心力衰竭。结果房颤组患者较非房颤组年龄更大(P<0.001)、男性及吸烟比例更高(P=0.018,P=0.006),且中性粒细胞百分比、超敏C反应蛋白、脑利钠肽前体水平更高(P=0.006,P<0.001,P<0.001),发病至接受冠脉介入治疗时间更长(P=0.035),而使用替罗非班药物比例、Killip分级水平更低(P=0.022,P=0.012)。Kaplan-Meier生存曲线发现房颤组较非房颤组发生心血管不良事件的时间更短(P<0.001),Cox回归分析显示急性心肌梗死患者急性期新发房颤与患者发生心血不良事件相关(P=0.017)。结论急性心肌梗死患者急性期新发房颤是发生心血管不良事件的独立危险因素。
Objective To investigate the relationship between new-onset atrial fibrillation(AF)and prognosis of patients after acute myocardial infarction(AMI).Methods Clinical data of 193 patients with AMI who hospitalized at Gongli Hospital and received coronary interventional therapy from July 2017 to January 2019 were retrospectively analyzed.The clinical characteristics and prognosis of the patients in AF group(n=25)and non-AF group(n=168)after AMI were compared.The median follow-up time was 23 months.The endpoint events include cardiac death,recurrence of non-fatal AMI,unplanned revascularization,rehospitalization for myocardial ischemia,ischemic stroke and heart failure.Results Compared with non-AF group,the AF group had older age,higher proportion of men and smokers,higher percentage of neutrophils,higher levels of hypersensitive C-reactive protein(h-CRP)and pro-brain natriuretic peptide(proBNP),longer time from onset to percutaneous coronary intervention(PCI),and lower proportion of taking tirofiban and lower killip grade.Kaplan-Meier survival curve showed that the time of adverse cardiac events in AF group was shorter than that in non-AF group.Cox regression analysis showed that new-onset AF in patients with AMI was significantly related to adverse cardiac events.Conclusion New-onset AF is an independent risk factor for adverse cardiac events in the patients with AMI.
作者
季舒亚
章凤
程龙
王海容
JI Shu-ya;ZHANG Feng;CHENG Long;WANG Hai-rong(Dept.of Cardiology,Shanghai Pudong New Area Gongli Hospital,Shanghai 200135,China)
出处
《同济大学学报（医学版）》
2021年第4期510-515,共6页
Journal of Tongji University(Medical Science)
基金
上海市浦东新区卫生系统特色专病项目(PWZzb2017-27)
上海市浦东新区公利医院青年基金资助计划(2018YQNJJ-14)。
关键词
急性心肌梗死
冠状动脉介入治疗
新发心房颤动
心血管不良事件
预后
acute myocardial infarction
percutaneous coronary intervention
new-onset atrial fibrillation
adverse cardiac events
prognosis
