CHA2DS2-VASc 评分联合 hs-CRP 对老年急性心肌梗死患者新发心房颤动的预测价值。

Predictive value of CHA2DS2-VASc score combined with hs-CRP for new-onset atrial fibrillation in elderly patients with acute myocardial infarction.

机构信息

Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.

出版信息

BMC Cardiovasc Disord. 2021 Apr 13;21(1):175. doi: 10.1186/s12872-021-01978-8.

BACKGROUND

New-onset atrial fibrillation (NOAF) is common during acute myocardial infarction (AMI) and independently associated with worse prognosis. We aimed to validate the discrimination performance of CHA2DS2-VASc score combined with hs-CRP in the prediction of NOAF after AMI in elderly Chinese population.

METHODS

311 consecutive elderly patients (age ≥ 65 years old) with AMI from 1 January 2018 to 1 January 2019 without atrial fibrillation history were enrolled in our study. Univariable and multivariable logistic regression analyses were used to identify risk factors of NOAF. The discrimination performance of different score models were evaluated using ROC curve analysis and AUCs were compared using the Z test.

RESULTS

30 (9.65%) patients developed NOAF during hospitalization. The NOAF group were older and had higher hs-CRP, initial Killip class, BNP, LAD, CHADS2 score, CHA2DS2-VASc score, in-hospital mortality and lower LVEF and ACEI/ARB use (P < 0.05 vs group without NOAF for all measures). In multivariate regression analyses, age (OR = 1.127, 95% CI 1.063-1.196, P < 0.001) and hs-CRP (OR = 1.034, 95% CI 1.018-1.05, P < 0.001) were independent predictors of NOAF. In ROC curve analyses, both CHADS2 score (AUC = 0.624, 95% CI 0.516-0.733, P = 0.026) and CHA2DS2-VASc score (AUC = 0.687, 95% CI 0.584-0.79, P = 0.001) had acceptable but unsatisfactory discrimination performance in predicting NOAF after AMI. The combined model with CHA2DS2-VASc score and hs-CRP showed a significant better predictive value (AUC = 0.791, 95% CI 0.692-0.891, P < 0.001) compared to that of the CHA2DS2-VASc score alone (Z test, P = 0.008).

CONCLUSION

The combined model with CHA2DS2-VASc score and hs-CRP had high accuracy in predicting post-AMI NOAF.

背景

新发心房颤动（NOAF）在急性心肌梗死（AMI）期间很常见，并且与预后较差独立相关。我们旨在验证 CHA2DS2-VASc 评分联合 hs-CRP 在预测中国老年人群 AMI 后 NOAF 中的区分性能。

方法

本研究纳入了 2018 年 1 月 1 日至 2019 年 1 月 1 日期间 311 例连续的 AMI 老年患者（年龄≥65 岁），且无心房颤动病史。采用单变量和多变量逻辑回归分析确定 NOAF 的危险因素。通过 ROC 曲线分析评估不同评分模型的区分性能，并通过 Z 检验比较 AUC 值。

结果

30 例（9.65%）患者在住院期间发生 NOAF。NOAF 组年龄较大，hs-CRP、初始 Killip 分级、BNP、LAD、CHADS2 评分、CHA2DS2-VASc 评分、院内死亡率较高，左心室射血分数（LVEF）和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）使用率较低（与无 NOAF 组相比，所有措施 P 值均<0.05）。多变量回归分析显示，年龄（OR=1.127，95%CI 1.063-1.196，P<0.001）和 hs-CRP（OR=1.034，95%CI 1.018-1.05，P<0.001）是 NOAF 的独立预测因素。ROC 曲线分析显示，CHADS2 评分（AUC=0.624，95%CI 0.516-0.733，P=0.026）和 CHA2DS2-VASc 评分（AUC=0.687，95%CI 0.584-0.79，P=0.001）在预测 AMI 后 NOAF 方面均具有可接受但不理想的区分性能。与单独使用 CHA2DS2-VASc 评分相比，联合 CHA2DS2-VASc 评分和 hs-CRP 的联合模型具有显著更好的预测价值（AUC=0.791，95%CI 0.692-0.891，P<0.001）（Z 检验，P=0.008）。