Mazzone Annamaria, Scalese Marco, Paradossi Umberto, Del Turco Serena, Botto Nicoletta, De Caterina Alberto, Trianni Giuseppe, Ravani Marcello, Rizza Antonio, Molinaro Sabrina, Palmieri Cataldo, Berti Sergio, Basta Giuseppina
Fondazione G. Monasterio CNR-Regione Toscana Pisa, Massa, Italy.
Institute of Clinical Physiology, CNR, Pisa, Italy.
Int J Clin Pract. 2018 Apr;72(4):e13087. doi: 10.1111/ijcp.13087. Epub 2018 Apr 17.
New-onset atrial fibrillation (NOAF) is a complication not infrequent in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) and has been associated with worse in-hospital and long-term prognosis. We aimed to develop and validate a risk score based on common clinical risk factors and routine blood biomarkers to assess the early incidence of NOAF post-pPCI, before discharge.
The risk score for NOAF occurrence during hospitalisation (about 5 days) was developed in a cohort of 1135 consecutive STEMI patients undergoing pPCI while was externally validated in a temporal cohort of 771 STEMI patients. Biomarkers and clinical variables significantly contributing to predicting NOAF were assessed by multivariate Cox-regression analysis.
Independent predictors of NOAF were age ≥80 years (6.97 [3.40-14.30], hazard ratio [95% CI], P < .001), leukocyte count > 9.68 × 10 /μL (2.65 [1.57-4.48], P < .001), brain natriuretic peptide (BNP) > 80 ng/L (2.37 [1.13-4.95], P = .02) and obesity (2.07 [1.09-3.92], P = .03). By summing the hazard ratios of these predictors we derived the ALBO (acronym derived from: Age, Leucocyte, BNP and Obesity) risk score which yielded high C-statistics in both the derivation (0.734 [0.675-0.793], P < .001) and validation cohort (0.76 [0.688-0.831], P < .001). In both cohorts, using Kaplan-Meier risk analysis, the ALBO score identified a tertile of patients at highest risk (ALBO >4 points), with percentages of NOAF incidence of 30.8% and 27.4% in the derivation and validation cohort, respectively.
The ALBO risk score, comprising biomarkers and clinical variables that can be assessed in hospital setting, could help to identify high-risk patients for NOAF after pPCI so that a prompter action can be taken.
新发房颤（NOAF）是接受直接经皮冠状动脉介入治疗（pPCI）的急性ST段抬高型心肌梗死（STEMI）患者中并不少见的一种并发症，并且与更差的住院和长期预后相关。我们旨在基于常见临床危险因素和常规血液生物标志物开发并验证一种风险评分，以评估pPCI后出院前NOAF的早期发生率。
在1135例连续接受pPCI的STEMI患者队列中开发了住院期间（约5天）发生NOAF的风险评分，并在771例STEMI患者的时间队列中进行了外部验证。通过多变量Cox回归分析评估对预测NOAF有显著贡献的生物标志物和临床变量。
NOAF的独立预测因素为年龄≥80岁（6.97[3.40 - 14.30]，风险比[95%CI]，P <.001）、白细胞计数>9.68×10⁹/μL（2.65[1.57 - 4.48]，P <.001）、脑钠肽（BNP）>80 ng/L（2.37[1.13 - 4.95]，P =.02）和肥胖（2.07[1.09 - 3.92]，P =.03）。通过将这些预测因素的风险比相加，我们得出了ALBO（源自年龄、白细胞、BNP和肥胖的首字母缩写）风险评分，该评分在推导队列（0.734[0.675 - 0.793]，P <.001）和验证队列（0.76[0.688 - 0.831]，P <.001）中均产生了较高的C统计量。在两个队列中，使用Kaplan-Meier风险分析，ALBO评分确定了风险最高的三分位数患者（ALBO>4分），推导队列和验证队列中NOAF发生率分别为30.8%和27.4%。
ALBO风险评分包括可在医院环境中评估的生物标志物和临床变量，有助于识别pPCI后发生NOAF的高危患者，以便能够采取更及时的行动。
