心房颤动与ST段抬高型心肌梗死患者介入术后短期主要不良心血管事件相关性研究  

Association between atrial fibrillation and short-term major adverse cardiovascular events among patients with ST-segment elevation myocardial infarction

作　　者：马珊珊[1] 张冬梅[2] 梁晓慧[1] MA Shanhan;ZHANG Dongmei;LIANG Xiaohui(Department of Cardiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心血管病中心高血压科,830054 [2]新疆维吾尔自治区人民医院呼吸与危重症医学中心

出　　处：《心肺血管病杂志》2023年第9期893-898,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探索在中国ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)人群中,心房颤动(atrial fibrillation,AF)对经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后30d主要不良心脑血管事件(major adverse cardiac cerebrovascular events,MACCE)的影响。方法:本研究为单中心回顾性研究,最终入选STEMI患者PCI术后患者297例。所有患者根据是否合并AF分为两组:无AF组(n=201)及AF组(n=96)。主要终点:30d MACCE,包括全因死亡、再发心肌梗死、心源性休克、心脏骤停、心力衰竭住院和卒中。次要终点:MACCE各独立组成部分。通过Logistic回归分析探究AF与30d MACCE之间的关系。使用亚组分析探究在不同亚组中AF对30d MACCE的影响并绘制森林图,结果用OR、95%CI和交互P表示。结果:AF组患者的30d MACCE发生率显著高于无AF组[19(19.8%),vs.19(9.5%),P<0.05],AF组患者的全因死亡[6(6.2%)vs.2(1.0%),P<0.05]的发生率显著高于无AF组。多元Logistic回归分析表明:AF组较无AF组发生30d MACCE的风险显著增加(OR=2.23,95%CI:1.03~4.49,P=0.043)。亚组分析表明,AF与30d MACCE的相关性受年龄影响,年龄偏大的患者AF对MACCE的影响更大(交互P=0.031)。结论:AF显著增加STEMI患者PCI术后30d MACCE、全因死亡的发生率,是30d MACCE发生的危险因素。。Objective:Ao explore the effect of atrial fibrillation(AF)on 30-day major adverse cardiovascular and cerebrovascular events(MACCE)in Chinese patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods:The study was a single-center retrospective cohort study,and 297 STEMI patients after PCI were finally enrolled.All patients were divided into two groups according to whether they had combined AF:no AF group(n=201)and AF group(n=96).Primary endpoint:30-day MACCE,including all-cause mortality,recurrent myocardial infarction,cardiogenic shock,cardiac arrest,hospitalization for heart failure and stroke.Secondary endpoint:each independent component of MACCE.The association between AF and 30-day MACCE was explored by Logistic regression analysis.The effect of AF on 30-day MACCE in different subgroups was explored using subgroup analysis and plotted in forest plots.Results:In this cohort,the incidence of 30-day MACCE was significantly higher in the AF group than in the no-AF group[19(19.8%),vs.19(9.5%),P<0.05],mainly due to a significantly higher incidence of all-cause mortality in the AF group than in the no-AF group[6(6.2%)vs.2(1.0%),P<0.05].Multiple Logistic regression analysis showed a significantly increased risk of 30-day MACCE in the AF group compared to the no-AF group(OR=2.23,95%CI:1.03-4.49,P=0.043).Subgroup analysis showed that the association between AF and 30-day MACCE was influenced by age,AF had a greater impact on MACCE in elder patients(P for interaction=0.031).Conclusions:AF significantly increased the incidence of 30-day MACCE,all-cause mortality in STEMI patients after PCI.AF was also an independent risk factor for the occurrence of 30-day MACCE.

关 键 词：心房颤动 ST段抬高型心肌梗死 主要不良心脑血管事件 冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]