Risk factors and the prediction model of new-onset atrial fibrillation in patients with acute myocardial infarction during hospitalization
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摘要: 目的:基于单中心数据探寻急性心肌梗死(AMI)患者新发心房颤动(房颤)的危险因素,建立列线图预测模型。方法:回顾性收集2016年1月—2019年12月因AMI住院的744例患者的临床资料,排除既往有房颤病史患者,根据住院期间是否出现新发房颤将患者分为新发房颤组(76例)和对照组(668例),通过单因素、多因素logistic回归分析新发房颤发生的独立危险因素,应用R软件建立预测新发房颤发生的列线图模型,并行模型内部验证。结果:多因素logistic逐步回归分析显示,年龄、心室率、射血分数减低、左心房内径增大是新发房颤的独立危险因素,依此构建列线图模型,评价分析示C指数为0.796(95%CI:0.742~0.850),校正曲线显示实际预测能力与理想的预测能力较为接近。结论:年龄、心室率、射血分数减低、左心房内径增大是AMI患者住院期间发生新发房颤的独立危险因素,本研究构建的列线图模型可以评估新发房颤的发生风险,具有一定的临床应用价值。Abstract: Objective: To interrogate risk factors for new-onset atrial fibrillation in patients with acute myocardial infarction based on single-center data and establish a nomogram prediction model.Methods: A total of 744 patients admitted to the hospital for acute myocardial infarction and without a history of atrial fibrillation from January 2016 to December 2019 were retrospectively collected. According to whether the patients had atrial fibrillation during their hospitalization, they were divided into the new-onset atrial fibrillation group(n=76) and the control group(n=668). Next, the independent risk factors of new-onset atrial fibrillation were analyzed by single-factor and multi-factor logistic regression analysis. Furthermore, the R software was used to establish a nomogram model for predicting the risk of new-onset atrial fibrillation, and this model was internally verified.Results: Multivariate logistic regression analysis showed that age, ventricular rate, reduced ejection fraction, and increased left atrial internal diameter were independent risk factors for new-onset atrial fibrillation. Based on this, the nomogram model was constructed, and the evaluation analysis showed that C-index was 0.796(95%CI: 0.742 to 0.850). The calibration curve showed that the actual predictive ability was closer to the ideal predictive power.Conclusion: Age, heart rate, reduced ejection fraction and increased left atrial internal diameter are independent risk factors for the development of new-onset atrial fibrillation during hospitalization in AMI patients, and the nomogram model constructed in this study could evaluate the risk of the development of new-onset atrial fibrillation and has specific clinical application.
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Key words:
- acute myocardial infarction /
- atrial fibrillation /
- new-onset /
- risk factor /
- nomogram
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[1] 王宇星,李闯,高元丰,等.急性ST段抬高型心肌梗死后新发心房颤动与长期心血管不良事件的关系[J].医学研究生学报,2020,33(7):741-747.
[2] 林捷,颜彦,施鸿毓.胸痛中心建设对急性心梗救治效率及预后影响的研究[J].临床急诊杂志,2019,20(10):767-770.
[3] 张智文,王山岭,刘静静,等.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[J].临床心血管病杂志,2020,36(6):540-544.
[4] Schmitt J,Duray G,Gersh BJ,et al.Atrial fibrillation in acute myocardial infarction:a systematic review of the incidence,clinical features and prognostic implications[J].Eur Heart J,2009,30(9):1038-1045.
[5] Jabre P,Roger VL,Murad MH,et al.Mortality associated with atrial fibrillation in patients with myocardial infarction:a systematic review and meta-analysis[J].Circulation,2011,123(15):1587-1593.
[6] 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.
[7] Wi J,Shin DH,Kim JS,et al.Transient new-onset atrial fibrillation is associated with poor clinical outcomes in patients with acute myocardial infarction[J].Circ J,2016,80(7):1615-1623.
[8] Kinjo K,Sato H,Sato H,et al.Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention[J].Am J Cardiol,2003,92(10):1150-1154.
[9] 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.
[10] Parashar S,Langberg JJ,Vaccarino V,et al.Elevated BNP predicts new onset atrial fibrillation comlicating acute myocardial infarction:analysis of the triumph registry[J].J Am Coll Cardiol,2010,55(10):A7.E61.
[11] Wang J,Yang YM,Zhu J.Mechanisms of new-onset atrial fibrillation complicating acute coronary syndrome[J].Herz,2015,40 Suppl 1:18-26.
[12] Writing Group Members,January CT,Wann LS,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].Heart Rhythm,2019,16(8):e66-e93.
[13] Schnabel RB,Yin X,Gona P,et al.50 year trends in atrial fibrillation prevalence,incidence,risk factors,and mortality in the Framingham Heart Study:a cohort study[J].Lancet,2015,386(9989):154-162.
[14] Guo Y,Tian Y,Wang H,et al.Prevalence,incidence,and lifetime risk of atrial fibrillation in China:new insights into the global burden of atrial fibrillation[J].Chest,2015,147(1):109-119.
[15] 田艳,魏晓艺,陈跃莲,等.急性心肌梗死后新发心房颤动危险因素的Meta分析[J].心肺血管病杂志,2019,38(12):1275-1279.
[16] Hwang HJ,Ha JW,Joung B,et al.Relation of inflammation and left atrial remodeling in atrial fibrillation occurring in early phase of acute myocardial infarction[J].Int J Cardiol,2011,146(1):28-31.
[17] Bahouth F,Mutlak D,Furman M,et al.Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction[J].Heart,2010,96(9):683-688.
[18] Zhang C,Zhao R,Chen F,et al.Preoperative prediction of microvascular invasion in non-metastatic hepatocellular carcinoma based on nomogram analysis[J].Transl Oncol,2021,14(1):100875.
[19] 殷菲.影响重症肺炎患者预后的相关因素分析及构建nomogram预测模型的价值研究[J].临床急诊杂志,2020,21(10):819-825.
[20] 冯六六,白艳艳,史骏,等.心内科住院患者高血压急症的危险因素分析及预测模型的建立[J].中国急救医学,2020,40(11):1072-1076.
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