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Objective To research the risk factors of new-onset atrial fibrillation (AF) during hospitalization in patients with acute myocardial infarction.Methods Five hundred and one patients first diagnosed with acute ST-segment elevation myocardial infarction who accepted primary coronary intervention from January 2012 to May 2014 in the Second Hospital of Tianjin Medical University were selected.These patients were divided into non-AF group and new-onset AF group depending on whether happened new-onset AF during hospitalization.Data of the patients in acute myocardial infarction complicated with new-onset atrial fibrillation were collected.Univariate and multivariate logistic regression analysis were used to determine the predictors of new-onset AF.Results AF occurred in 49 cases of the 501 (9.8％) patients diagnosed as acute myocardial infarction.Logistic regression analysis showed that admission heart rate(OR =1.019,95％CI:1.004-1.034,P =0.012),left atrial diameter (OR =1.086,95％ CI:1.021-1.156,P =0.009),previous stroke (OR =2.060,95％ CI:1.029-4.123,P =0.041) were independent risk factors for new-onset AF in acute myocardial infarction.Use of β-blockers before coronary intervention treatment can reduce the risk of new-onset atrial fibrillation(OR=0.222,95％CI:0.064-0.768,P=0.017).Conclusion Admission heart rate and left atrial diameter are independent predictors of new-onset atrial fibrillation,and β-blockers in early stage can effectively reduce the incidence of atrial fibrillation.
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Objective To investigate the predictive value of CHADS2 and CHA2DS2-VASc score in left atrial (LA) or left atrial appendage (LAA) thrombus in patients with non-valvular atrial fibrillation (AF). Methods A total of 164 consecu?tive non-valvular AF patients confirmed by transesophageal echocardiography (TEE) were included in this study, and were divided into two groups, LA/LAA thrombus group and non LA/LAA thrombus group. The previous history was recorded in two groups of patients. Their CHADS2 and CHA2DS2-VASC scores were calculated based on the general data of two groups. The laboratory examinations and TEE indexes were compared between two gropes. Results Of all patients, the rate of LA/LAA thrombus was 19.5%. The CHADS2 and CHA2DS2-VASC scores were significantly higher in LA/LAA thrombus group than those of non LA/LAA thrombus group (2.1±1.3 vs 1.0±0.9, 3.4±1.8 vs 1.9±1.4,P<0.01). There were 13(11.9%) and 5 (8.8%) patients showed LA/LAA thrombus under low-moderate risk in the two score systems, respectively. Multivariate logis?tic regression analysis showed that CHADS2 score≥2 points(OR=3.735, 95%CI:1.508-9.251, P=0.004) and CHA2DS2-VASc score ≥2 points (OR=5.104, 95%CI:1.586-16.425, P=0.006) were independent risk factors of LA/LAA thrombus. ROC curve showed that AUC of CHADS2 and CHA2DS2-VASc scores to predict LA/LAA thrombus were 0.731 (95%CI:0.630-0.832, P<0.001) and 0.742 (95%CI:0.640-0.843, P<0.001), respectively. Conclusion CHADS2 and CHA2DS2-VASC score ≥2 points are independent risk factors of LA/LAA thrombus in patients with non-valvular atrial fibrillation. The pre?dictive values of both score systems are moderate. There are also LA/LAA thrombus in low-moderate risk patients when us?ing the two score systems, and with the increased risk stratification, the rate of LA/LAA thrombus is increased.
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<p><b>OBJECTIVE</b>To explore the relationship between fragmented QRS complexes (fQRS) and imperfect ST-segment resolution in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI).</p><p><b>METHODS</b>This study included 227 consecutive patients with STEMI who underwent p-PCI. They were divided into two groups: ECG with fQRS (n = 142) and without fQRS (n = 85). Baseline clinical characteristics,Gensini score, coronary angiography features and the rate of ST-segment resolution were compared between the two groups.</p><p><b>RESULTS</b>(1) Patients with fQRS of ECG had higher cTnI, CK, CK-MB levels and Gensini score, prolonged QRS interval, lower rate of ST-segment resolution and left ventricular ejection fraction (LVEF) than in patients without fQRS (all P < 0.01 or P < 0.05). (2) Pearson correlation analysis showed that the rate of ST-segment resolution (r = -0.207, P = 0.002),Gensini score (r = 0.191, P = 0.004), LVEF(r = -0.188, P = 0.006), cTnI(r = 0.172, P = 0.010), and the TIMI grade post p-PCI (r = -0.148, P = 0.028) were significantly related with the presence of fQRS. (3) Multivariate logistic regression analysis demonstrated that presence of fQRS at pre-PCI (OR = 2.908, 95%CI:1.095-7.723, P = 0.032) , the number of leads with fQRS before PCI (OR = 1.582, 95%CI:1.250-2.002, P < 0.001), and increased QRS interval (OR = 0.955, 95%CI: 0.924-0.988, P = 0.008) were independent predictors of imperfect ST-segment resolution.</p><p><b>CONCLUSIONS</b>fQRS is related to imperfect ST-segment resolution in STEMI patients undergoing p-PCI.fQRS may be a useful parameter to identify the patients with severe coronary lesion, larger areas of ischemic injury and myocardial infarction as well as severe left ventricular contracted dysfunction.</p>