急性心肌梗死并发心房颤动/心房扑动的影响因素及预后分析

Influential factors and prognostic significance of atrial fibrillation/atrial flutter complicating acute myocardial infarction

目的分析急性心肌梗死(AMI)患者合并心房颤动(atrial fibrillation,Af)/心房扑动(atria flutter,AF)的发病率、临床特点、影响因素及其对院内死亡的影响。方法将我院收治的653例AMI患者分为Af/AF组(61例)及无Af/AF组(592例),分析发生Af/AF的相关危险因素;再根据是否在院内死亡分为院内死亡组(64例)及未死亡组(589例),评估Af/AF对AMI患者院内死亡的影响。结果AMI患者初发Af/AF的发生率为9.3%。单因素分析显示,Af/AF组与无Af/AF组在年龄、性别、入院时心率、心肌梗死范围、Killip分级、左心室射血分数、入院时血肌酐水平及血红蛋白水平均有显著性差异(P<0.05)。Af/AF组与无Af/AF组多因素logistic回归分析显示,多部位心肌梗死、女性是影响AMI患者发生Af/AF的最主要独立危险因素;院内死亡组与未死亡组多因素lo-gistic回归分析显示,Af/AF是影响AMI患者院内死亡的独立危险因素。结论Af/AF是AMI患者常见的并发症,合并Af/AF的患者住院期间的预后更差。

Objective To evaluate the incidence, clinical features, influential factors and prognostic significance of atrial fibrillation/atrial flutter（Af/AF）complicating acute myocardial infarction （AMI）. Methods 653 patients admitted for AMI in Peking University First hospital were evaluated. Firstly, the patients were divided into Af/AF group and non-Af/AF group. Logistic regression analysis was used to identify the risk factors for Af/AF. Then the patients were divided on the basis of in-hospital mortality into mortality group and non-mortality group. Logistic regression analysis was used to assess the influence of Af/AF on in-hospital mortality. Results New onset of Af/AF was documented in 61 AMI patients（9.3%）. There were significant differences between Af/AF and non-Af/AF patients in age, sex, MI extent, heart rate, Killip class, LVEF, serum ereatinine and hemoglobin level on admission. Multi-locations of MI and female sex were the main risk factors for Af/AF. Af/AF patients had higher in-hospital mortality. Af/AF was the independent risk factor for in-hospital mortality. Conclusion Af/AF is a common complication of AMI and independently influences in-hospital mortality.