Department of Geriatric Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China.
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China.
BMC Cardiovasc Disord. 2024 Sep 27;24(1):521. doi: 10.1186/s12872-024-04200-7.
New-onset atrial fibrillation (NOAF) is a common adverse outcome in acute ST-segment elevation myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI) and is associated with a worse prognosis. The platelet-to-albumin ratio (PAR) has been utilized to predict the severity and prognosis of cardiovascular diseases. This study aims to investigate the predictive value of PAR combined with the CHEST score for NOAF in the elderly population with STEMI undergoing PCI.
445 elderly STEMI patients without a history of atrial fibrillation (AF) who underwent PCI were consecutively enrolled in this study. Multivariate logistic regression analysis was used to identify independent risk factors for NOAF after PCI.
50 patients (11.2%) developed NOAF after PCI. Multivariate logistic regression analysis revealed that heart rate (HR), systemic immune-inflammation index (SII), uric acid (UA), PAR, and CHEST score were independent risk factors for NOAF. The area under the curve (AUC) of the combined PAR and CHEST score was 0.839, and Delong's test indicated that the combined model had superior predictive value compared to individual markers (AUC of PAR: 0.738; AUC of CHEST score: 0.752) (P < 0.05). The addition of PAR and CHEST score to this model (HR, SII, and UA) significantly improved the reclassification and discrimination ability (IDI 0.175; NRI 0.734, both P < 0.001). During regular follow-up, the incidence of MACE was higher in the NOAF group compared to the non-NOAF group.
The combination of PAR and the CHEST score has a high predictive value for NOAF in elderly STEMI patients following PCI.
新发心房颤动（NOAF）是急性 ST 段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后的常见不良结局，与预后不良相关。血小板/白蛋白比值（PAR）已被用于预测心血管疾病的严重程度和预后。本研究旨在探讨 PAR 联合 CHEST 评分对老年 STEMI 患者 PCI 后新发心房颤动的预测价值。
连续纳入 445 例无心房颤动（AF）病史的老年 STEMI 患者，行 PCI 治疗。采用多因素 logistic 回归分析确定 PCI 后新发心房颤动的独立危险因素。
50 例（11.2%）患者 PCI 后发生新发心房颤动。多因素 logistic 回归分析显示，心率（HR）、全身免疫炎症指数（SII）、尿酸（UA）、PAR 和 CHEST 评分是新发心房颤动的独立危险因素。PAR 和 CHEST 评分联合模型的曲线下面积（AUC）为 0.839，Delong 检验表明联合模型的预测价值优于单个标志物（PAR 的 AUC：0.738；CHEST 评分的 AUC：0.752）（P<0.05）。将 PAR 和 CHEST 评分加入该模型（HR、SII 和 UA）可显著提高再分类和判别能力（IDI 0.175；NRI 0.734，均 P<0.001）。在常规随访期间，NOAF 组的 MACE 发生率高于非 NOAF 组。
PAR 联合 CHEST 评分对老年 STEMI 患者 PCI 后新发心房颤动具有较高的预测价值。
