Zhao Ting-Ting, Pan Tian-Jiao, Yang Yi-Bo, Pei Xiao-Yang, Wang Yong
Department of Cardiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China.
Department of Day-Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Front Cardiovasc Med. 2023 Sep 21;10:1207219. doi: 10.3389/fcvm.2023.1207219. eCollection 2023.
Previous studies have indicated that the soluble suppression of tumorigenicity 2 protein (sST2) is associated with new-onset atrial fibrillation (NOAF) in patients diagnosed with coronary artery disease (CAD). However, the predictive value of sST2 in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been well studied.
A total of 580 patients with STEMI undergoing primary PCI were consecutively recruited between January 2021 and January 2023. These patients were then categorized into two groups: the NOAF group and the no NOAF groups based on the presence of NOAF during admission. The concentration of sST2 in blood samples was measured in all patients. The clinical data from the two groups were prospectively analyzed to investigate the predictive factors of NOAF in patients with STEMI undergoing primary PCI.
A total of 41 (7.1%) patients developed NOAF. The presence of NOAF has been found to be associated with various factors, including age, diabetes mellitus, hypertension, the left atrial (LA) diameter, N-terminal pro-brain natriuretic peptide, C-reactive protein (CRP), sST2, a Killip class of ≥2, and a final TIMI flow grade of <3. After including multiple factors, it was observed that LA diameter, CRP, sST2, a Killip class of ≥2, and a final TIMI flow grade of <3 remained significant risk factors for developing NOAF. The receiver operating characteristic (ROC) curve showed the following findings: (1) when the LA diameter exceeded 38.5 mm, the sensitivity and specificity values were observed to be 67.2% and 68.2%, respectively, and the area under the ROC curve (AUC) was 0.683 [95% confidence interval (CI): 0.545-0.732; = 0.003]; (2) when the CRP level exceeded 8.59, the sensitivity and specificity values were observed to be 68.6% and 69.2%, respectively, and the AUC was 0.713 (95% CI: 0.621-0.778; < 0.001); and (3) when the sST2 value exceeded 53.3, the sensitivity and specificity values were 79.2% and 68.7%, respectively, and the AUC was 0.799 (95% CI: 0.675-0.865; < 0.001).
sST2 has been identified as an independent predictor of NOAF in patients with STEMI undergoing PCI.
既往研究表明，可溶性肿瘤抑制因子2蛋白（sST2）与诊断为冠状动脉疾病（CAD）患者的新发房颤（NOAF）相关。然而，sST2在接受直接经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者中的预测价值尚未得到充分研究。
2021年1月至2023年1月连续纳入580例接受直接PCI的STEMI患者。然后根据入院期间是否存在NOAF将这些患者分为两组：NOAF组和无NOAF组。测定所有患者血样中sST2的浓度。对两组的临床资料进行前瞻性分析，以探讨接受直接PCI的STEMI患者发生NOAF的预测因素。
共有41例（7.1%）患者发生NOAF。已发现NOAF的存在与多种因素相关，包括年龄、糖尿病、高血压、左心房（LA）直径、N末端脑钠肽前体、C反应蛋白（CRP）、sST2、Killip分级≥2级以及最终心肌梗死溶栓治疗（TIMI）血流分级<3级。纳入多个因素后，观察到LA直径、CRP、sST2、Killip分级≥2级以及最终TIMI血流分级<3级仍然是发生NOAF的显著危险因素。受试者工作特征（ROC）曲线显示以下结果：（1）当LA直径超过38.5 mm时，灵敏度和特异度值分别为67.2%和68.2%，ROC曲线下面积（AUC）为0.683[95%置信区间（CI）：0.545-0.732；P = 0.003]；（2）当CRP水平超过8.59时，灵敏度和特异度值分别为68.6%和69.2%，AUC为0.713（95%CI：0.621-0.778；P < 0.001）；（3）当sST2值超过53.3时，灵敏度和特异度值分别为79.2%和68.
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