急性ST段抬高心肌梗死患者合并新发心房颤动的危险因素

Risk factors for acute ST-segment elevation myocardial infarction combined with new-onset atrial fibrillation

目的探讨急性ST段抬高心肌梗死(ASTEMI)患者合并新发心房纤颤(NOAF)的危险因素。方法回顾性278例ASTEMI患者的临床资料,其中88例住院期间发生NOAF(观察组),190例未发生NOAF(对照组)。收集患者的一般资料、实验室检查指标、心脏彩超检测指标、冠状动脉造影结果和用药情况。采用多因素Logistic模型分析ASTEMI合并NOAF的影响因素,并比较两组住院期间的主要不良心血管事件发生率。结果Logistic回归分析结果显示,高龄、心泵功能分级≥Ⅱ级是ASTEMI合并NOAF的危险因素,而使用β受体抑制剂是ASTEMI合并NOAF的保护因素(均P<0.05)。住院期间观察组的心力衰竭加重、严重心律失常、心源性猝死发生率均高于对照组(均P<0.05)。结论高龄、心泵功能分级≥Ⅱ级的ASTEMI患者易发生NOAF,而使用β受体阻滞剂可降低NOAF发生风险;ASTEMI合并NOAF患者住院期间的主要心脏不良事件发生率较高,应针对相应因素进行及早干预,以改善临床预后。

Objective To explore the risk factors for acute ST-segment elevation myocardial infarction(ASTEMI)complicated with new-onset atrial fibrillation(NOAF).Methods The clinical data of 278 ASTEMI patients were analyzed retrospectively,including 88 cases developing NOAF during hospitalization(observation group)and 190 cases without NOAF(control group).General data,laboratory test indices,cardiac color ultrasound indicators,coronary angiographic findings and personal drug prescription were collected in the patients.The influencing factors of ASTEMI complicated with NOAF were analyzed using the multivariate Logistic model,and the incidence rates of major adverse cardiovascular events during hospitalization were compared between the two groups.Results Logistic regression analysis results showed that older age and cardiac pump function classification≥gradeⅡwere the risk factors for ASTEMI complicated with NOAF,and the use ofβreceptor inhibitors was a protective factor for ASTEMI complicated with NOAF(all P<0.05).During hospitalization,the incidence rates of aggravated heart failure,severe arrhythmia,and sudden cardiac death in the observation group were higher than those in the control group(all P<0.05).Conclusion ASTEMI patients with older age or cardiac pump function classification≥gradeⅡare more likely to develop NOAF,those with the use ofβreceptor inhibitors might have a lower risk of developing NOAF;patients with ASTEMI complicated with NOAF have a higher incidence rate of major adverse cardiovascular events during hospitalization,interventions should be done promptly targeting corresponding factors,thus achieving improvement in clinical prognosis.