急诊经皮冠状动脉介入术后新发心房颤动的相关性因素研究

Correlative factors of new onset atrial fibrillation after emergency percutaneous coronary intervention

目的探讨因急性心肌梗死(AMI)急诊行经皮冠状动脉介入治疗(PCI)后患者新发心房颤动(NOAF)的相关因素。方法纳入2014年7月—2018年3月因AMI于天津市武清区人民医院住院治疗并行急诊PCI的患者402例,对患者进行1年期随访,按是否存在NOAF分为NOAF组(55例)和非NOAF组(347例)。比较两组患者的年龄、性别、血压、血肌酐、合并症、超声心动图测量指标、冠状动脉造影和介入治疗结果、Syntax积分等,以差异有统计学意义的因素为自变量,采用logistic回归分析筛选NOAF发生的危险因素。结果AMI急诊PCI术后患者NOAF发生率为13.68%(55/402)。两组患者的年龄、收缩压、Syntax积分、左心房内径、血肌酐,以及吸烟、合并高血压病、冠状动脉性心脏病(简称冠心病)、肾功能不全和病变血管支数的构成差异均有统计学意义(P值分别<0.05,0.01)。将上述自变量引入logistic回归分析显示,冠心病(OR=1.035,95%CI为1.003~1.069,P<0.05)、肾功能不全(OR=4.045,95%CI为1.439~11.369,P<0.01)、Syntax积分(OR=2.002,95%CI为1.007~3.980,P<0.05)、左心房内径(OR=1.263,95%CI为1.117~1.428,P<0.01)是急诊PCI术后患者NOAF的危险因素。结论冠心病、肾功能不全、Syntax积分和左心房内径是急诊PCI术后患者NOAF的危险因素,对于临床预测NOAF的发生有一定的应用价值。

Objective To investigate the correlative factors of new onset atrial fibrillation(NOAF) after emergency percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI). Methods A total of 402 patients with AMI who underwent emergency PCI between July 2014 and March 2018 were selected in this study. After one-year follow up, patients were divided into NOAF group(n=55) and non NOAF group(n=347). Clinical data including age, gender, blood pressure, creatinine, complications, ultrasonic cardiogram indexes, coronary arteriography results, and interventional therapeutic outcome and Syntax score were compared between the two groups. The indicators with statistically significant differences were further analyzed by logistics regression analysis to screen the risk factors of NOAF. Results The incidence of NOAF was 13.68%(55/402) in this study. There were significant differences in age, systolic pressure, Syntax score, left atrial diameter, creatinine, the history of smoking, hypertension, coronary heart disease and renal insufficiency, and the number of lesion vessels between two groups(P<0.05,0.01). Logistic regression analysis showed that coronary heart disease history(odds ratio [OR]=1.035, 95%CI: 1.003-1.069, P<0.05), renal insufficiency history(OR=4.045, 95%CI: 1.439-11.369, P<0.01), Syntax score(OR=2.002, 95%CI: 1.007-3.980, P<0.05) and left atrial diameter(OR=1.263, 95%CI: 1.117-1.428, P<0.01) were independent risk factors of NOAF. Conclusion The occurrence of NOAF after emergency PCI is related with coronary heart disease, renal insufficiency history, Syntax score and left atrial diameter. They can be used to predict the occurrence of NOAF.