Lin Cheng-Jei, Liu Chu-Feng, Kung Chia-Te, Sun Cheuk-Kwan, Lin Yu-Chun, Leu Steve, Chua Sarah, Yeh Kuo-Ho, Wu Chiung-Jen, Chen Yung-Lung, Yip Hon-Kan
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
Int Heart J. 2011;52(3):153-8. doi: 10.1536/ihj.52.153.
This study evaluated the association between atrial fibrillation (AF) and 30-day clinical outcome in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Between January 2005 and October 2009, 783 consecutive patients with acute STEMI undergoing primary PCI were enrolled. Of these patients, 85 (10.9%) with AF during admission were categorized into group 1, while the remaining 698 (89.1%) with sinus rhythm during admission served as group 2. The results demonstrated that the incidence of advanced Killip score (defined as ≥ score 3) and advanced congestive heart failure (defined as ≥ NYHA class 3) were significantly higher, whereas the left ventricular ejection fraction (LVEF) was notably lower in group 1 than in group 2 (all P < 0.003). Additionally, the normal blood flow in the infarct-related artery was notably lower in group 1 than in group 2 (P = 0.003). Moreover, the incidences of new-onset stroke and 30-day mortality were remarkably higher in group 1 than in group 2 (all P < 0.003). Furthermore, Kaplan-Meier analysis demonstrated that the 30-day survival rate was markedly lower in AF patients than in those with sinus rhythm. However, multivariate stepwise Cox regression analysis demonstrated that the advanced Killip score and low LVEF were significantly and independently predictive of 30-day mortality (all P < 0.004). In conclusion, AF was significantly associated with 30-day mortality.
本研究评估了接受直接经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者中，心房颤动（AF）与30天临床结局之间的关联。在2005年1月至2009年10月期间，连续纳入了783例接受直接PCI的急性STEMI患者。在这些患者中，85例（10.9%）入院时伴有AF被归入第1组，而其余698例（89.１%）入院时为窦性心律作为第2组。结果显示，第1组中高级Killip评分（定义为≥3分）和重度充血性心力衰竭（定义为≥纽约心脏协会3级）的发生率显著更高，而左心室射血分数（LVEF）则明显低于第2组（所有P<0.003）。此外，第1组梗死相关动脉的正常血流明显低于第2组（P=0.003）。而且，第1组中新发卒中的发生率和30天死亡率显著高于第2组（所有P<0.003）。此外，Kaplan-Meier分析表明，AF患者的30天生存率明显低于窦性心律患者。然而，多因素逐步Cox回归分析表明，高级Killip评分和低LVEF是30天死亡率的显著且独立预测因素（所有P<0.004）。总之，AF与30天死亡率显著相关。
