左心房大小与前壁与非前壁 ST 段抬高型心肌梗死患者 2.5 年临床结局的不同相关性。

Different associations between left atrial size and 2.5-year clinical outcomes in patients with anterior versus non-anterior wall ST-elevation myocardial infarction.

机构信息

Clinical Research Centre, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

出版信息

J Int Med Res. 2020 Apr;48(4):300060520912073. doi: 10.1177/0300060520912073.

DOI:10.1177/0300060520912073

PMID:32252575

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7140218/

Abstract

OBJECTIVE

To investigate associations between left atrial diameter (LAD) and long-term outcomes in patients with anterior or non-anterior wall ST-elevation myocardial infarction (STEMI).

METHODS

Patients with STEMI were included in this secondary analysis of data from a prospective cohort study in which the primary outcome was major adverse cardiovascular event (MACE) occurrence during a 2.5-year follow-up. A LAD cut-off value was obtained through receiver operating characteristic curve analysis. Kaplan-Meier curve and Cox regression analyses were applied. Subgroup Cox regression analysis was also performed, with patients stratified based on left ventricular diastolic diameter (LVEDD, > 55 mm and ≤55 mm). The relationship between LAD and outcomes in patients with anterior or non-anterior wall STEMI was explored using restricted cubic spline functions.

RESULTS

Out of 464 patients, adjusted Cox regression showed that dichotomous (>40 mm) LAD was significantly associated with MACE (hazard ratio 2.978, 95% confidence interval 1.763, 5.030) in patients with anterior wall but not non-anterior wall STEMI. The association was not different between normal and enlarged LVEDD groups.

CONCLUSIONS

A left atrium > 40 mm may indicate higher risk of MACE in patients with anterior wall STEMI, even in patients with normal left ventricular structure. This relationship was not observed in patients with non-anterior wall STEMI.

摘要

目的

探讨左心房直径（LAD）与前壁或非前壁 ST 段抬高型心肌梗死（STEMI）患者长期预后的关系。

方法

本研究为一项前瞻性队列研究的二次分析，纳入了 STEMI 患者，主要结局为 2.5 年随访期间主要不良心血管事件（MACE）的发生。通过受试者工作特征曲线分析获得 LAD 截断值。采用 Kaplan-Meier 曲线和 Cox 回归分析。还进行了亚组 Cox 回归分析，根据左心室舒张直径（LVEDD，>55mm 和≤55mm）对患者进行分层。采用限制性立方样条函数探讨 LAD 与前壁和非前壁 STEMI 患者预后的关系。

结果

在 464 例患者中，调整后的 Cox 回归显示，在前壁 STEMI 患者中，二分类（>40mm）LAD 与 MACE 显著相关（危险比 2.978，95%置信区间 1.763，5.030），但在非前壁 STEMI 患者中无显著相关性。在正常 LVEDD 组和扩大 LVEDD 组之间，这种相关性没有差异。