Department of General and Specialized Surgery "Paride Stefanini", Sapienza University of Rome, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.
Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Int J Cardiol. 2023 Sep 1;386:45-49. doi: 10.1016/j.ijcard.2023.05.023. Epub 2023 May 17.
New onset atrial fibrillation (NOAF) is associated with worse clinical outcomes after acute coronary syndrome (ACS). Identification of ACS patients at risk of NOAF remains challenging. To test the value of the simple CHEST score for predicting NOAF in patients with ACS.
We studied patients from the prospective ongoing multicenter REALE-ACS registry of patients with ACS. NOAF was the primary endpoint of the study. The CHEST score was calculated as coronary artery disease or chronic obstructive pulmonary disease (1 point each), hypertension (1 point), elderly (age ≥ 75 years, 2 points), systolic heart failure (2 points), thyroid disease (1 point). We also tested the mCHEST score.
We enrolled 555 patients (mean age 65.6 ± 13.3 years; 22.9% women), of which 45 (8.1%) developed NOAF. Patients with NOAF were older (p < 0.001) and had more prevalent hypertension (p = 0.012), chronic obstructive pulmonary disease (p < 0.001) and hyperthyroidism (p = 0.018). Patients with NOAF were more frequently admitted with STEMI (p < 0.001), cardiogenic shock (p = 0.008), Killip class ≥2 (p < 0.001) and had higher mean GRACE score (p < 0.001). Patients with NOAF had a higher CHEST score compared with those without (4.2 ± 1.7 vs 3.0 ± 1.5, p < 0.001). A CHEST score > 3 was associated with NOAF occurrence (odds ratio 4.33, 95% confidence interval 2.19-8.59, p < 0.001). ROC curve analysis showed good accuracy of the CHEST score (AUC 0.71, 95%CI 0.67-0.74) and mCHEST score (AUC 0.69, 95%CI 065-0.73) in predicting NOAF.
The simple CHEST score may be a useful tool to identify patients at higher risk of developing NOAF after presentation with ACS.
新发心房颤动（NOAF）与急性冠状动脉综合征（ACS）后临床结局恶化相关。识别 ACS 患者发生 NOAF 的风险仍然具有挑战性。本研究旨在检验 CHEST 评分预测 ACS 患者新发心房颤动的价值。
我们研究了前瞻性多中心 REALE-ACS 注册登记的 ACS 患者。新发心房颤动（NOAF）是本研究的主要终点。CHEST 评分的计算方法为：冠心病或慢性阻塞性肺疾病（各 1 分）、高血压（1 分）、老年（年龄≥75 岁，2 分）、收缩性心力衰竭（2 分）、甲状腺疾病（1 分）。我们还检验了 mCHEST 评分。
共纳入 555 例患者（平均年龄 65.6±13.3 岁，22.9%为女性），其中 45 例（8.1%）发生了 NOAF。发生 NOAF 的患者年龄更大（p<0.001），更常见高血压（p=0.012）、慢性阻塞性肺疾病（p<0.001）和甲状腺功能亢进（p=0.018）。发生 NOAF 的患者更常因 ST 段抬高型心肌梗死（STEMI）（p<0.001）、心源性休克（p=0.008）、Killip 分级≥2 级（p<0.001）入院，平均 GRACE 评分更高（p<0.001）。与未发生 NOAF 的患者相比，发生 NOAF 的患者 CHEST 评分更高（4.2±1.7 与 3.0±1.5，p<0.001）。CHEST 评分>3 与发生 NOAF 相关（比值比 4.33，95%置信区间 2.19-8.59，p<0.001）。ROC 曲线分析显示 CHEST 评分（AUC 为 0.71，95%CI 为 0.67-0.74）和 mCHEST 评分（AUC 为 0.69，95%CI 为 0.65-0.73）预测 NOAF 均具有良好的准确性。
简单的 CHEST 评分可能是一种有用的工具，可用于识别 ACS 患者发生 NOAF 的风险较高。
