Shiba Taiki, Kondo Yusuke, Senoo Keitaro, Nakano Masahiro, Okubo Kenji, Ishio Naoki, Shikama Nobuaki, Kobayashi Yoshio
Department of Cardiology, Chiba Aoba Municipal Hospital.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine.
Int Heart J. 2019 Nov 30;60(6):1308-1314. doi: 10.1536/ihj.18-713. Epub 2019 Oct 31.
Although atrial ischemic damage is an atrial fibrillation (AF) risk factor, the impact of atrial branches' occlusion on AF development after acute myocardial infarction (AMI) is unclear. Therefore, this study's purpose was to identify predictors of new-onset AF with regard to atrial branches' occlusion. We retrospectively analyzed the AMI database at our single center. Consecutive patients with AMI from June 2011 to May 2017 were enrolled. Exclusion criteria were prior AF before AMI, hemodialysis, and follow-up of < 30 days. The study enrolled 204 consecutive patients (follow-up, 543 ± 469 days; age, 66 ± 12 years; male sex, 77%). All patients underwent primary percutaneous coronary intervention. Thirty-six patients (18%) had new-onset AF in the hospital after AMI. The Killip classification ≥ 3 (41% versus 7%, P < 0.001), ejection fraction ≤ 35% (19% versus 5%, P = 0.014), ischemic occlusion of atrial branches (58% versus 28%, P < 0.001), and ischemic occlusion of atrial branches originating from the right coronary artery (52% versus 18%, P < 0.001) were more frequent in patients with new-onset AF. Multivariable logistic regression analysis showed that Killip classification ≥ 3 (odds ratio, 6.97; 95% confidence interval [CI], 2.77-17.52; P < 0.001), and ischemic occlusion of the atrial branch of the right coronary artery (odds ratio, 4.35; 95% confidence interval, 1.91-9.93; P < 0.001) were independent predictors of new-onset AF. Altogether, proximal occlusion in the right coronary artery involving the atrial branch is a strong predictor of new-onset AF after AMI.
虽然心房缺血性损伤是心房颤动（AF）的一个危险因素，但急性心肌梗死（AMI）后心房分支闭塞对AF发生发展的影响尚不清楚。因此，本研究的目的是确定与心房分支闭塞相关的新发AF的预测因素。我们回顾性分析了我们单中心的AMI数据库。纳入了2011年6月至2017年5月连续的AMI患者。排除标准为AMI前有AF、血液透析以及随访时间<30天。该研究连续纳入了204例患者（随访时间为543±469天；年龄为66±12岁；男性占77%）。所有患者均接受了直接经皮冠状动脉介入治疗。36例患者（18%）在AMI后住院期间出现新发AF。新发AF患者中Killip分级≥3（41%对7%，P<0.001）、射血分数≤35%（19%对5%，P = 0.014）、心房分支缺血性闭塞（58%对28%，P<0.001）以及起源于右冠状动脉的心房分支缺血性闭塞（52%对18%，P<0.001）更为常见。多变量逻辑回归分析显示，Killip分级≥3（比值比，6.97；95%置信区间[CI]，2.77 - 17.52；P<0.001）以及右冠状动脉心房分支缺血性闭塞（比值比，4.35；95%置信区间，1.91 - 9.93；P<0.001）是新发AF的独立预测因素。总之，右冠状动脉近端闭塞累及心房分支是AMI后新发AF的一个强有力的预测因素。
