频发房性期前收缩与老年急性ST段抬高型心肌梗死患者新发心房颤动的关系及其预测价值研究

Relationship between frequent premature atrial contraction and new-onset atrial fibrillation in gerontal patients with acute ST-segment elevation myocardial infarction

目的:探讨频发房性期前收缩(FPAC)与老年急性ST段抬高型心肌梗死(STEMI)患者新发心房颤动(NOAF)的关系以及FPAC对老年急性STEMI患者NOAF的预测价值。方法:将纳入研究的330例年龄≥60岁的急性STEMI患者按照24 h出现的房性期前收缩(PAC)次数分为FPAC组(PAC≥720次/24 h,91例)和非FPAC组(PAC<720次/24 h,239例),分别计算两组患者发生NOAF的概率。再将纳入研究的330例患者按照是否发生NOAF分为NOAF组(32例)和非NOAF组(298例),分析两组患者的一般临床资料、PAC次数、超声心动图指标、冠状动脉造影结果和治疗药物之间是否存在差异,采用Logistic回归方程分析STEMI患者发生NOAF的相关危险因素,使用ROC曲线评价FPAC预测老年急性STEMI患者发生NOAF的价值。结果:FPAC组患者的NOAF发生率明显高于非FPAC组(20.9%∶5.4%,P<0.05);与非NOAF组相比,NOAF组患者伴有心力衰竭、高血压的患者较多、PAC频率更高、左心房内径(LAD)更大、左心室射血分数(LVEF)较低、右冠闭塞者较多(P<0.05),而两组性别、抽烟、饮酒、BMI、糖尿病史、肾功能不全、脑卒中史、血脂异常、肺动脉收缩压(PASP)和治疗方法比较差异无统计学意义(P>0.05)。多因素Logistic分析显示,合并心力衰竭、高血压史、较高的PAC频率、LAD增大、LVEF降低和右冠病变是老年STEMI患者发生NOAF的独立危险因素(P<0.05);ROC曲线结果显示,FPAC预测老年STEMI患者发生NOAF的AUC为0.816(95%CI:0.769~0.856,P<0.001)。结论:在老年急性STEMI患者中,较高的PAC频率与NOAF之间关系密切,FPAC可作为STEMI患者发生NOAF的早期预测指标。

Objective:To investigate the relationship between frequent premature atrial contraction(FPAC)and new-onset atrial fibrillation(NOAF)in gerontal patients with acute ST-elevation myocardial infarction(STEMI)and the value of using FPAC to predict NOAF in STEMI patients.Methods:Three hundred and thirty acute STEMI patients aged at least 60 years were included in the study;they were divided into FPAC group(PAC≥720/24 h,n=91)and non-FPAC group(PAC<720/24 h,n=239)according to the number of premature atrial contraction(PAC)in 24 hours.The probability of NOAF in the two groups was calculated respectively.Then these 330 patients were divided into NOAF group(n=32)and non-NOAF group(n=298)according to the occurrence of NOAF.the differences in general clinical data,PAC frequency,echocardiographic indicators,coronary angiography results and treatment drugs between the two groups were analyzed.The Logistic regression equation was used to analyze the risk factors of NOAF in STEMI patients.ROC curve was used to evaluate the value of FPAC in predicting NOAF in elderly STEMI patients.Results:The incidence of NOAF in patients in the FPAC group was significantly higher than that in the non-FPAC group(20.9%vs 5.4%,P<0.05).Compared with the non-NOAF group,the NOAF group had more patients with heart failure or hypertension.Patients in the NOAF group had higher PAC frequency,higher left atrial diameter(LAD),and lower left ventricular ejection fraction(LVEF);also,more patients with right coronary artery occlusion(P<0.05).There was no significant difference between the two groups in terms of gender,smoking,drinking,body mass index,diabetes,renal insufficiency,stroke history,dyslipidemia,pulmonary artery systolic pressure(PASP),and treatment methods(P>0.05).Multivariate Logistic regression analysis showed that heart failure,hypertension,higher PAC frequency,increased LAD,decreased LVEF and right coronary artery occlusion were independent risk factors for NOAF in elderly STEMI patients(P<0.05).ROC curve analysis showed that the AUC for FPAC predicting the occurrence of NOAF in gerontal STEMI patients was 0.816(95%CI:0.769-0.856,P<0.001).Conclusion:In gerontal patients with acute STEMI,higher PAC frequency is closely related to NOAF,and FPAC can be used as an early predictor of NOAF in STEMI patients.