急性心肌梗死患者CHADS_2评分与他汀类药物治疗对新发心房颤动预防作用的相关性

Relationship between CHADS_2 risk score and statin use on new-onset atrial fibrillation in patients with acute myocardial infarction

目的 确认CHADS2[C（congestive heart failure）H （hypertension）A （age）D （diabetes Mellitus）S2（prior stroke or transient ischemic attack）]危险评分是否与急性心肌梗死（acute myocardial infarction,AMI）患者新发心房颤动（atrial fibrillation,AF）存在相关性,以及是否有助于确定AMI后从使用他汀类药物预防AF发生的最大获益者.方法 连续性收集于2011年10月至2013年11月就诊于广东省人民医院的724例AMI患者.根据CHADS2评分,所有患者被分为3组：A组=0分;B组=1～2分;C组=3～6分.研究终点是患者在住院期间出现的持续时间超过30 s的新发AF发作.结果 78例患者（10.8％）出现新发AF,而682例患者（94.2％）接受了他汀类药物治疗.新发AF的发病率从A组到C组逐步升高,组间比较差异有统计学意义（P=0.017）.他汀类药物的使用（OR =0.22,95％CI=0.06～0.85）和CHADS2评分（OR=1.53,95％ CI=1.02～2.28）均为AMI患者新发AF的独立危险因素.CHADS2评分≤2的患者的C-反应蛋白浓度显著降低,且如果他们服用他汀类药物,新发AF的风险显著降低（P＜0.05）.多因素回归分析显示,对CHADS2评分≤2的患者使用他汀类药物预防新发AF是有效的（OR=0.34,95％CI=0.14～0.81）.结论 CHADS2评分有助于确定AMI后从使用他汀类药物预防AF发生的最大获益者.

Objectives To determine whether the CHADS2 [C （congestive heart failure）H （hypertension）A （age）D （diabetes mellitus）S2 （prior stroke or transient ischemic attack）] score is associated with new-onset atrial fibrillation （AF） in patients with acute myocardial infarction（AMI） and whether it is helpful to identify the patients who will benefit most from statin use for the prevention of arrhythmia after AMI.Methods A total of 724 consecutive AMI patients in Guangdong General Hospital from October 2011 to November 2013 were enrolled in this study.The patients were divided into 3 groups according to their CHADS2 scores：group A,score 0; group B,score 1-2; and group C,score 3-6.The endpoint of this study was an episode of new-onset AF that lasted more than 30 seconds during hospitalization at the coronary care unit.Results Seventy-eight （10.8%） patients developed new-onset AF,and 682 （94.2%） were on a statin therapy upon admission.Incidence of new-onset AF increased significantly and gradually from group A to group C （P=0.017）.Statinuse （OR=0.22,95%CI=0.06-0.85） and CHADS2score （OR=1.53,95%CI=1.02-2.28） were independent predictors of new-onset AF in patients with AMI.Concentration of C-reactive protein and risk of new-onset AF significantly reduced in patients with CHADS2 score ≤ 2 if they received statins therapy （P〈0.05）.Multivariate Logistic regression analysis demonstrated the benefit of statin use for preventing new-onset AF in patients with CHADS2 scores ≤2 （OR=0.34,95% CI=0.14-0.81）.Conclusions The CHADS2 score can help identifying patients who will benefit most from statin use for the prevention of AF after AMI.