Șerban Răzvan Constantin, Șuș Ioana, Lakatos Eva Katalin, Demjen Zoltan, Ceamburu Alexandru, Fișcă Paul Ciprian, Somkereki Cristina, Hadadi Laszlo, Scridon Alina
University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania.
Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania.
Acta Cardiol. 2019 Dec;74(6):472-479. doi: 10.1080/00015385.2018.1521558. Epub 2019 Jan 16.
Atrial fibrillation (AF) often complicates ST-segment elevation myocardial infarction (STEMI). Predictors of AF in this setting include factors related to the acute phase of STEMI and pre-existing conditions. More recently, novel AF predictors have been identified in the general population. We aimed to assess the ability of such novel factors to predict STEMI-related AF. Data were collected from STEMI patients treated by primary PCI. Factors related to the acute phase of STEMI (Killip class, heart rate, blood pressure on admission, post-PCI TIMI flow), classic (age, hypertension, heart failure, previous myocardial infarction), and more novel (body mass index [BMI], diabetes, chronic kidney disease [CKD], chronic obstructive pulmonary disease [COPD]) AF predictors were evaluated. The ability of these novel factors to predict STEMI-related AF was assessed. Of the 629 studied patients, 10.5% presented STEMI-related AF. AF patients had higher Killip class on admission ( < .0001) and lower post-PCI TIMI flow ( < .01), they were older ( < .0001) and more likely to have a history of heart failure ( = .02) and myocardial infarction ( = .04). BMI, history of diabetes and COPD were similar between patients with and without AF (all > .05), but CKD was more common in AF patients ( < .0001). In multiple regression analysis, CKD remained a strong independent predictor of STEMI-related AF ( < .0001). Irrespective of other factors, CKD was associated with increased risk of STEMI-related AF. CKD could be used to identify patients who will develop AF in this setting and who would benefit from closer follow-up and more intensive prophylactic strategies.
心房颤动（AF）常使ST段抬高型心肌梗死（STEMI）病情复杂化。这种情况下AF的预测因素包括与STEMI急性期相关的因素以及既往存在的疾病。最近，在普通人群中已识别出新型AF预测因素。我们旨在评估此类新型因素预测STEMI相关AF的能力。数据收集自接受直接经皮冠状动脉介入治疗（PCI）的STEMI患者。评估了与STEMI急性期相关的因素（Killip分级、心率、入院时血压、PCI术后心肌梗死溶栓治疗（TIMI）血流）、经典的（年龄、高血压、心力衰竭、既往心肌梗死）以及更新的（体重指数[BMI]、糖尿病、慢性肾脏病[CKD]、慢性阻塞性肺疾病[COPD]）AF预测因素。评估了这些新型因素预测STEMI相关AF的能力。在629例研究患者中，10.5%出现了STEMI相关AF。AF患者入院时Killip分级更高（<0.0001）且PCI术后TIMI血流更低（<0.01），他们年龄更大（<0.0001），且更可能有心力衰竭病史（=0.02）和心肌梗死病史（=0.04）。有AF和无AF患者的BMI、糖尿病史和COPD史相似（均>0.05），但CKD在AF患者中更常见（<0.0001）。在多元回归分析中，CKD仍然是STEMI相关AF的强有力独立预测因素（<0.0001）。无论其他因素如何，CKD都与STEMI相关AF风险增加有关。CKD可用于识别在此情况下会发生AF的患者，以及那些将从更密切随访和更强化预防策略中获益的患者。
