背景急性心肌梗死(AMI)是新发心房颤动(NOAF)的急性病因,而NOAF又可导致AMI病情恶化。因此,明确AMI患者NOAF的危险因素并早期干预对改善患者预后、降低病死率具有积极意义。目的探讨AMI患者住院期间NOAF的危险因素,以期能早期识别伴有...背景急性心肌梗死(AMI)是新发心房颤动(NOAF)的急性病因,而NOAF又可导致AMI病情恶化。因此,明确AMI患者NOAF的危险因素并早期干预对改善患者预后、降低病死率具有积极意义。目的探讨AMI患者住院期间NOAF的危险因素,以期能早期识别伴有高危心房颤动的AMI患者。方法本研究为回顾性研究。选取2014-06-01至2019-06-01石家庄市第三医院收治的648例AMI患者,其中住院期间出现NOAF 91例(房颤组);按照1∶2的比例从未出现NOAF的557例AMI患者中随机选取182例作为非房颤组。收集患者临床资料,包括一般资料、心脏超声检查结果、冠状动脉造影结果及住院期间严重临床事件发生情况。结果房颤组患者年龄和左心房内径(LAD)大于非房颤组,脑血管病、陈旧性心肌梗死、中重度左房室瓣反流、室性心动过速/心室颤动、心源性死亡发生率及收缩压<100 mm Hg、心率≥100次/min、左心室射血分数(LVEF)<40%者所占比例高于非房颤组,Killip分级劣于非房颤组(P<0.05)。多因素Logistic回归分析结果显示,年龄≥70岁[OR=3.636,95%CI(1.928,6.858)]、LAD>40 mm[OR=3.013,95%CI(1.475,6.158)]、收缩压<100 mm Hg[OR=5.056,95%CI(1.438,17.771)]、Killip分级≥2级[OR=4.130,95%CI(1.751,9.738)]是AMI患者NOAF的独立影响因素(P<0.05)。结论年龄≥70岁、LAD>40 mm、收缩压<100 mm Hg、Killip分级≥2级的AMI患者NOAF风险较高,应引起临床医生重视。展开更多
Background： Recent observational studies have shown that patients with higher Killips score （〉Ⅰ） have higher risk of new-onset atrial fibrillation （NOAF） following acute myocardial infarction （AMI）, while oth...Background： Recent observational studies have shown that patients with higher Killips score （〉Ⅰ） have higher risk of new-onset atrial fibrillation （NOAF） following acute myocardial infarction （AMI）, while others drew a neutral conclusion. The ultimate predictive value of high Killips class on NOAF remained obscure. Methods： PubMed, Web of Science, China National Knowledge Infrastructure, and the Cochrane Controlled Trials Register Databases were searched until February 2015. Of the 3732 initially identified studies, 5 observational studies with 10,053 patients were analyzed. Results： The meta-analysis of these studies showed that higher Killips score on admission was associated with higher incidence of NOAF following AMI （odds ratio 2.29, 95% confidence intcrwd 1.96 2.67, P 〈 0.00001 ）, while no significant differences exist among individual trials （P =0.14 and I^2= 43%）. Conclusions： Killips class 〉I was associated with the higher opportunity of developing NOAF following AMI.展开更多
文摘背景急性心肌梗死(AMI)是新发心房颤动(NOAF)的急性病因,而NOAF又可导致AMI病情恶化。因此,明确AMI患者NOAF的危险因素并早期干预对改善患者预后、降低病死率具有积极意义。目的探讨AMI患者住院期间NOAF的危险因素,以期能早期识别伴有高危心房颤动的AMI患者。方法本研究为回顾性研究。选取2014-06-01至2019-06-01石家庄市第三医院收治的648例AMI患者,其中住院期间出现NOAF 91例(房颤组);按照1∶2的比例从未出现NOAF的557例AMI患者中随机选取182例作为非房颤组。收集患者临床资料,包括一般资料、心脏超声检查结果、冠状动脉造影结果及住院期间严重临床事件发生情况。结果房颤组患者年龄和左心房内径(LAD)大于非房颤组,脑血管病、陈旧性心肌梗死、中重度左房室瓣反流、室性心动过速/心室颤动、心源性死亡发生率及收缩压<100 mm Hg、心率≥100次/min、左心室射血分数(LVEF)<40%者所占比例高于非房颤组,Killip分级劣于非房颤组(P<0.05)。多因素Logistic回归分析结果显示,年龄≥70岁[OR=3.636,95%CI(1.928,6.858)]、LAD>40 mm[OR=3.013,95%CI(1.475,6.158)]、收缩压<100 mm Hg[OR=5.056,95%CI(1.438,17.771)]、Killip分级≥2级[OR=4.130,95%CI(1.751,9.738)]是AMI患者NOAF的独立影响因素(P<0.05)。结论年龄≥70岁、LAD>40 mm、收缩压<100 mm Hg、Killip分级≥2级的AMI患者NOAF风险较高,应引起临床医生重视。
基金Source of Support： This study was partly supported by grants from the National Natural Science Foundation of China （No. 30900618, No. 81270245）. Conflict of Interest： None declared.
文摘Background： Recent observational studies have shown that patients with higher Killips score （〉Ⅰ） have higher risk of new-onset atrial fibrillation （NOAF） following acute myocardial infarction （AMI）, while others drew a neutral conclusion. The ultimate predictive value of high Killips class on NOAF remained obscure. Methods： PubMed, Web of Science, China National Knowledge Infrastructure, and the Cochrane Controlled Trials Register Databases were searched until February 2015. Of the 3732 initially identified studies, 5 observational studies with 10,053 patients were analyzed. Results： The meta-analysis of these studies showed that higher Killips score on admission was associated with higher incidence of NOAF following AMI （odds ratio 2.29, 95% confidence intcrwd 1.96 2.67, P 〈 0.00001 ）, while no significant differences exist among individual trials （P =0.14 and I^2= 43%）. Conclusions： Killips class 〉I was associated with the higher opportunity of developing NOAF following AMI.
