Podolecki Tomasz, Lenarczyk Radoslaw, Kowalczyk Jacek, Jedrzejczyk-Patej Ewa, Swiatkowski Andrzej, Chodor Piotr, Sedkowska Agnieszka, Streb Witold, Mitrega Katarzyna, Kalarus Zbigniew
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center of Heart Diseases, Zabrze, Poland.
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center of Heart Diseases, Zabrze, Poland.
Am J Cardiol. 2017 Aug 15;120(4):517-521. doi: 10.1016/j.amjcard.2017.05.017. Epub 2017 May 30.
The aim of the present study is to assess the clinical impact of atrial fibrillation (AF) in patients with ST-segment elevation myocardial infarction (STEMI) complicated by new-onset AF depending on STEMI location and timing of arrhythmia. We analyzed 4,363 consecutive STEMI patients treated invasively. Finally, 4,099 subjects were included into further analysis, as 264 patients were excluded because of previous AF history. In total, 1,800 (43.9%) subjects with anterior infarction were included into Group 1, whereas Group 2 encompassed 2,299 (56.1%) patients with nonanterior infarction. Subsequently, both groups were divided into patients with new-onset AF (AF Group 1 and 2, respectively) and without AF (Control Group 1 and 2). New-onset AF was recognized in 225 patients (5.5%): 96 (5.3%) with an anterior wall infarction (AF Group 1) and 129 (5.6%) with a nonanterior wall infarction (AF Group 2). The incidence of early-onset arrhythmia (within 24 hours after admission) was significantly higher in AF Group 2 than in AF Group 1: 71.3% versus 35.4% (p <0.001). In Group 1, both early- and late-onset AFs were associated with significantly increased in-hospital mortality compared with AF-free population (17.7% and 27.4%, respectively vs 6.3%; p <0.05), whereas in Group 2, in-hospital mortality was increased only in subjects with late-onset AF compared with AF-free population (13.5% vs 4.2%, p <0.05). New-onset AF was the independent predictor of death only in Group 1 (hazard ratio 2.16) and this effect was stronger for late-onset AF (hazard ratio 2.86). In conclusion, 1 in 20 patients with STEMI treated invasively was affected by new-onset AF. The predictive value of new-onset AF was strongly related with STEMI location and timing of arrhythmia.
本研究旨在评估ST段抬高型心肌梗死（STEMI）合并新发房颤患者中房颤（AF）的临床影响，具体取决于STEMI的部位和心律失常发生的时间。我们分析了4363例接受侵入性治疗的连续STEMI患者。最终，4099名受试者纳入进一步分析，264例患者因既往有房颤病史而被排除。总共，1800例（43.9%）前壁梗死患者被纳入第1组，而第2组包括2299例（56.1%）非前壁梗死患者。随后，两组患者又被分为新发房颤患者（分别为房颤第1组和第2组）和无房颤患者（对照组1和2）。225例患者（5.5%）被诊断为新发房颤：96例（5.3%）为前壁梗死（房颤第1组），129例（5.6%）为非前壁梗死（房颤第2组）。房颤第2组早期心律失常（入院后24小时内）的发生率显著高于房颤第1组：分别为71.3%和35.4%（p<0.001）。在第1组中，与无房颤人群相比，早期和晚期房颤均与院内死亡率显著增加相关（分别为17.7%和27.4%，对比6.3%；p<0.05），而在第2组中，与无房颤人群相比，仅晚期房颤患者的院内死亡率增加（13.5%对比4.2%，p<0.05）。新发房颤仅在第1组中是死亡的独立预测因素（风险比2.16），且这种影响在晚期房颤中更强（风险比2.86）。总之，每20例接受侵入性治疗的STEMI患者中有1例受新发房颤影响。新发房颤的预测价值与STEMI部位和心律失常发生时间密切相关。
