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急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后预后营养指数与新发房颤的关系

Relationship Between Prognostic Nutritional Index and New-Onset Atrial Fibrillation in Patients with Acute ST-Elevation Myocardial Infarction Following Percutaneous Coronary Intervention.

作者信息

Xie Xiangrong, Chen Yan, Gan Weipeng, Liang Cheng, Zuo Quan, Zhou Yimeng, Cheng Yuliang, Wang Xinyu, Luo Zhimin, Tang Shengxing, Ling Yang

机构信息

Department of Cardiology, Yijishan Hospital, Wannan Medical College.

Department of Cardiology, Taishan People's Hospital.

出版信息

Int Heart J. 2023 Jul 29;64(4):543-550. doi: 10.1536/ihj.22-647. Epub 2023 Jul 14.

Abstract

Multiple reports relate new-onset atrial fibrillation (NOAF) to poor clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) who received percutaneous coronary intervention (PCI). The prognostic nutritional index (PNI) is a reliable indicator of immunonutritional-inflammatory status, and it is linked to clinical outcomes in cardiovascular disease patients. This research aims to explore the relationship between NOAF and PNI.Overall, 600 STEMI patients treated with PCI were recruited for this retrospective analysis. The patients were categorized into the NOAF group or sinus rhythm (SR) group. Logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to assess PNI estimation. Lastly, the Kaplan-Meier curve was used to compare all-cause mortality between both groups.The combined NOAF incidence in PCI-treated STEMI patients was 7.7%. PNI was independently correlated with NOAF using multivariate regression analyses (odds ratio [OR], 0.824; 95% confidence interval [CI], 0.750-0.906; P < 0.001). In ROC curve analyses, the best PNI threshold value for predicting NOAF was 40.1, with sensitivity, and specificity of 76.09% and 71.30%, respectively area under the curve, 0.787; 95% CI, 0.752-0.819; P < 0.001). After a median of 41-month follow-up, the Kaplan-Meier curve revealed that the NOAF patients displayed an elevated all-cause death incidence compared with SR patients, with a log-rank of P = 0.005.This study demonstrated that PNI is an independent predictor of NOAF in STEMI patients during hospitalization after PCI, which is strongly correlated with a poor outcome upon discharge.

摘要

多项报告指出,新发房颤(NOAF)与接受经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者的不良临床结局相关。预后营养指数(PNI)是免疫营养 - 炎症状态的可靠指标,且与心血管疾病患者的临床结局相关。本研究旨在探讨NOAF与PNI之间的关系。

总体而言,本回顾性分析纳入了600例接受PCI治疗的STEMI患者。这些患者被分为NOAF组或窦性心律(SR)组。进行逻辑回归和受试者工作特征(ROC)曲线分析以评估PNI估计值。最后,使用Kaplan - Meier曲线比较两组的全因死亡率。

接受PCI治疗的STEMI患者中,NOAF的合并发生率为7.7%。多变量回归分析显示PNI与NOAF独立相关(比值比[OR],0.824;95%置信区间[CI],0.750 - 0.906;P < 0.001)。在ROC曲线分析中,预测NOAF的最佳PNI阈值为40.1,灵敏度和特异度分别为76.09%和71.30%,曲线下面积为0.787;95% CI,0.752 - 0.819;P < 0.001)。经过中位41个月的随访,Kaplan - Meier曲线显示,与SR患者相比,NOAF患者的全因死亡发生率升高,对数秩检验P = 0.005。

本研究表明,PNI是PCI术后住院期间STEMI患者发生NOAF的独立预测因子,且与出院时的不良结局密切相关。

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