ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗和药物-侵入策略治疗下新发心房颤动的研究

张智文; 王山岭; 刘静静; 吴金涛; 王婷; 赵丹清; 范宪伟; 严丽洁; 杨海涛

doi:10.13201/j.issn.1001-1439.2020.06.010

ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗和药物-侵入策略治疗下新发心房颤动的研究

- 1. 河南大学人民医院河南省人民医院心血管内科(郑州, 450003);
- 2. 河南省人民医院心脏中心华中阜外医院心血管内科
基金项目:
河南省科技计划项目（No：182102310175）

详细信息

通讯作者: 杨海涛,E-mail:yanghaitaotougao@163.com

中图分类号: R541.75

收稿日期: 2020-03-19

修回日期: 2020-03-23

Study of new atrial fibrillation in patients with ST elevation myocardial infarction under primary percutaneous coronary intervention and pharmaco-invasive strategy

- 1. Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China;
- 2. Department of Cardiology, Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital

More Information

Corresponding author: YANG Haitao, E-mail: yanghaitaotougao@163.com

Received Date: 19 March 2020

Revised Date: 23 March 2020

摘要

摘要: 目的：探讨急性ST段抬高型心肌梗死（STEMI）患者中新发心房颤动（NOAF）的发生率、危险因素和预后，并比较药物-侵入策略（PIS）和直接经皮冠状动脉介入治疗（PPCI）2种不同治疗方法患者的NOAF发生率、危险因素和预后是否存在差异。方法：回顾性分析341例STEMI患者的临床资料，按照治疗方法分为PIS组（170例，进一步亚组分析按照患者是窦性心律（SR）或NOAF将PIS组分为PIS-SR组和PIS-NOAF组）和PPCI组（171例，同样进一步分为PPCI-SR组和PPCI-NOAF组），分析2组患者的一般临床资料、超声心动图指标和冠状动脉造影结果，并分别评估2组患者NOAF的发生率、危险因素和预后。结果：PIS组NOAF的发生率为11.2%，PPCI组NOAF的发生率为10.5%，2组比较差异无统计学意义（P>0.05），2组患者年龄、性别等一般临床资料、超声心动图指标和冠状动脉造影结果比较，差异无统计学意义（P>0.05），2组患者预后比较差异无统计学意义（P>0.05）；PIS组的亚组分析显示，PIS-NOAF组患者较PIS-SR组患者高龄和高血压更多，左房容积指数（LAVI）更高，左室射血分数（LVEF）更低，右冠为责任血管者更多（P<0.05）；PPCI亚组分析结果与PIS组相似，PPCI-NOAF组较PPCI-SR组患者高龄和高血压更多，LAVI更高，LVEF更低，右冠为责任血管者更多（P<0.05）；对所有NOAF患者和SR患者进行单因素分析结果显示，NOAF患者中高龄和高血压患者较多，LAVI较高，LVEF较低，右冠为责任血管者更多（P<0.05）；多元Logistic回归方程结果显示，PPCI组和PIS组STEMI患者NOAF的独立危险因素均为高龄、高血压、LAVI升高、LVEF降低和右冠为责任血管。结论：NOAF是STEMI的常见并发症，高龄、高血压、LAVI增大、LVEF降低和右冠为责任血管是NOAF的独立危险因素。PIS组与PPCI组在NOAF的发生率、危险因素和预后方面无明显差异。
- 急性心肌梗死 /
- 药物-侵入策略 /
- 直接经皮冠状动脉介入治疗 /
- 新发心房颤动
Abstract: Objective: To investigate the incidence, predictors and prognosis of new-onset atrial fibrillation (NOAF) in patients with acute ST elevation myocardial infarction (STEMI), and to compare the incidence, predictors and prognosis of NOAF between patients receiving pharmaco-invasive strategy (PIS) andpatients receiving the primary percutaneous coronary intervention (PPCI).Method: The clinical data of 341 STEMI patients were retrospectively analyzed and divided into PIS group (n=170, further divided into PIS-SR group and PIS-NOAF group according to whether the patient was sinus rhythm or NOAF) and PPCI group (n=171, also further divided into PPCI-SR group and PPCI-NOAF group) according to the treatment methods.The general clinical data, echocardiographic indexes and coronary angiography results of the two groups were analyzed, and the incidence, predictive factors and prognosis of NOAF in the two groups were evaluated.Result: The incidence of NOAF was 11.2% in the PIS group and 10.5% in the PPCI group, with no significant difference(P>0.05).There was no significant difference in age, gender and other general clinical data, echocardiographic indexes and coronary angiography results between the two groups (P>0.05).There was no significant difference in prognosis between the two groups of patients (P>0.05).The subgroup analysis of the PIS group showed that the number of elderly and hypertensive patients in the NOAF group was higher than that in the sinus rhythm group, there were more patients with higher LAVI, lower LVEF and more patients with right coronary artery occlusion in PPCI subgroup (P<0.05).The results of PPCI subgroup analysis were similar to those in PIS group, and there were more elderly and hypertensive patients in NOAF group, higher LAVI, lower LVEF and more patients with right coronary artery occlusion (P<0.05).Single factor analysis of all patients with NOAF and sinus rhythm showed that the elderly and hypertensive patients in NOAF group, there were more patients, higher LAVI, lower LVEF and more right coronary artery occlusion (P<0.05).The results of multiple logistic regression equations showed that in the PPCI group and the PIS group, the independent risk factors for NOAF in STEMI patients were advanced age, hypertension, increased LAVI, decreased LVEF, and responsible right coronary artery.Conclusion: NOAF is a common complication of STEMI. Elderly age, hypertension, increased left atrial volume index, decreased left ventricular ejection fraction and right coronary artery occlusion are independent predictors of NOAF.There was no significant difference in the incidence, predictors and prognosis of NOAF between PIS group and PPCI group.
- acute myocardial infarction /
- pharmaco-invasive strategy /
- primary percutaneous coronary intervention /
- new onset atrial fibrillation

HTML全文

参考文献(16)

[1]	马长生.2019年心房颤动治疗新进展[J].临床心血管病杂志, 2019, 35(11):967-971.
[2]	Consuegra-Sánchez L, Melgarejo-Moreno A, Galcerá-Tomás J, et al.Short- and long-term prognosis of previous and new-onset atrial fibrillation in ST-segment elevation acute myocardial infarction[J].Rev Esp Cardiol(Engl Ed), 2014, 68(1):31-38.
[3]	Lopes RD, Elliott LE, White HD, et al.Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention:results from the APEX-AMI trial[J].Eur Heart J, 2009, 30(16):2019-2028.
[4]	Khalfallah M, Elsheikh A, Abdalaal M, et al.Very early versus early percutaneous coronary intervention after successful fibrinolytic therapy in pharmacoinvasive strategy[J].Glob Heart, 2018, 13(4):261-265.
[5]	Khalfallah M, Abdalaal M, Adel M, et al.Contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction:is it affected by treatment strategy?[J].Glob Heart, 2019, 14(3):295-302.
[6]	马娜, 顾明.介入治疗≥ 75岁的高龄急性ST段抬高型心肌梗死患者的临床特征和预后分析[J].临床心血管病杂志, 2019, 35(12):1119-1123.
[7]	Romanov A, Martinek M, Pürerfellner H, et al.Incidence of atrial fibrillation detected by continuous rhythm monitoring after acute myocardial infarction in patients with preserved left ventricular ejection fraction:results of the ARREST study[J].Europace, 2018, 20(2):263-270.
[8]	Guenancia C, Toucas C, Fauchier L, et al.High rate of recurrence at long-term follow-up after new-onset atrial fibrillation during acute myocardial infarction[J].Europace, 2018, 20(12):e179-e188.
[9]	Kundu A, Oday K, Shaikh A Y, et al.Relation of atrial fibrillation in acute myocardial infarction to in-hospital complications and early hospital readmission[J].Am J Cardiol, 2016, 117(8):1213-1218.
[10]	Duytschaever M, De Pooter J, Demolder A, et al.Long-term impact of catheter ablation on arrhythmia burden in low-risk patients with paroxysmal atrial fibrillation:The CLOSE to CURE study[J].Heart Rhythm, 2019, 11(004):237-245.
[11]	Jons C, Jacobsen UG, Joergensen RM, et al.The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction:A CARISMA substudy[J].Heart Rhythm, 2011, 8(3):342-348.
[12]	Romanov A, Martinek M, Purerfellner H, et al.Incidence of atrial fibrillation detected by continuous rhythm monitoring after acute myocardial infarction in patients with preserved left ventricular ejection fraction:results of the ARREST study[J].Europace, 2018, 20(2):263-270.
[13]	January CT, Wann LS, Calkins H, et al.2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol, 2019, 74(1):104-132.
[14]	Vukmirovic M, Boškovic A, Tomaševic Vukmirovic I, et al.Predictions and outcomes of atrial fibrillation in the patients with acute myocardial infarction[J].Open Med (Wars), 2017, 12(1):115-124.
[15]	Crenshaw BS, Ward SR, Granger CB, et al.Atrial fibrillation in the setting of acute myocardial infarction:The GUSTO-I experience[J].J Am Coll Cardiol, 30(2):406-413.
[16]	Rhyou HI, Park TH, Cho YR, et al.Clinical factors associated with the development of atrial fibrillation in the year following STEMI treated by primary PCI[J].J Cardiol, 2018, 71(2):125-128.