ST段抬高型心肌梗死患者高度房间阻滞与新发心房颤动的关系

Advanced Interatrial Block is Associated With New-onset Atrial Fibrillation in Patients With ST-segment Elevation Myocardial Infarction

目的:房间阻滞(interatrial block,IAB)是一种左右心房传导延迟的现象,被认为是心房纤维化的心电图表现。本研究旨在探讨ST段抬高型心肌梗死(STEMI)患者高度IAB与住院期间新发心房颤动(房颤)的关系。方法:本研究为单中心回顾性观察性研究,连续入选于2019年9月至2022年6月在徐州医科大学附属医院诊断为STEMI的患者共916例。所有患者均在发病12 h内接受急诊经皮冠状动脉介入治疗,且在第一次医疗接触时记录并上传心电图至中国胸痛中心官方平台。分析STEMI患者中IAB的检出率及新发房颤的发生率,并采用Logistic回归分析法评估STEMI患者住院期间新发房颤的影响因素。结果:269例(29.4%)STEMI患者检测到IAB,其中57例(21.2%)患者为高度IAB。89例(9.7%)患者在住院期间新发房颤。多因素回归分析显示,年龄(OR=1.070,95%CI:1.045~1.095,P<0.001)、左心室射血分数(OR=0.929,95%CI:0.901~0.957,P<0.001)、右冠状动脉病变(OR=1.672,95%CI:1.042~2.683,P=0.033)和高度IAB(OR=4.007,95%CI:1.973~8.138,P<0.001)为STEMI患者住院期间新发房颤的独立影响因素。将高度IAB加入新发房颤风险模型后,该模型综合判别改善指数(IDI)和净重分类指数(NRI)均明显提高,C指数达0.742。结论:高度IAB是STEMI患者住院期间新发房颤的独立影响因素,有助于改善对STEMI患者住院期间新发房颤风险的预测。

Objectives:Interatrial block(IAB)is a conduction delay between the right and left atria,which is a phenomenon recognized as an electrocardiogram(ECG)feature of atrial fibrosis.This study aimed to investigate the relationship between advanced IAB and in-hospital new-onset atrial fibrillation(NOAF)in patients with ST-segment elevation myocardial infarction(STEMI).Methods:This single-center retrospective observational study consecutively enrolled 916 patients diagnosed with STEMI from September 2019 to June 2022,who underwent primary percutaneous coronary intervention within 24 hours of onset.ECG was recorded in all patients at the first medical contact,and the ECG was scanned and uploaded on the official China Chest Pain Center platform.The detection rate of IAB and the incidence of NOAF in STEMI patients were analyzed,and the possible associated factors of new-onset atrial fibrillation during hospitalization of STEMI patients were evaluated by logistic regression analysis.Results:IAB was detected in 269(29.4%)patients,57(21.2%)of these patients had advanced IAB.In-hospital NOAF was detected in 89(9.7%)patients.Multivariate analysis showed age(OR=1.070,95%CI:1.045-1.095,P<0.001),left ventricular ejection fraction(OR=0.929,95%CI:0.901-0.957,P<0.001),right coronary artery lesion(OR=1.672,95%CI:1.042-2.683,P=0.033),and advanced IAB(OR=4.007,95%CI:1.973-8.138,P<0.001)were independent determinants of in-hospital NOAF among STEMI patients.Integrated discrimination improvement(IDI)and net reclassification improvement(NRI)were improved significantly when advanced IAB was included in the NOAF risk model with a satisfactory C index(0.742).Conclusions:Advanced IAB is an independent risk marker for NOAF in patients with STEMI.Advanced IAB has incremental impact for improving the discriminatory accuracy of the NOAF predicting model.