ABSTRACT
ObjectiveNeNewly onset atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI), which is considered to be related to cardiovascular adverse events. This paper aims to discuss the relationship between atrial fibrillation and long-term cardiovascular adverse events after acute myocardial infarction.MethodsA retrospective analysis of 483 STEMI patients with multivessel disease, who underwent emergency percutaneous coronary intervention (PCI) in Beijing Chaoyang Hospital from January 2014 to May 2017, was conducted. Patients were divided into two groups: AF group: n=52(10.8%) and non-AF group: n=431(89.2%) according to including criteria. The primary endpoint event was long-term major adverse cardiovascular events, including cardiovascular death, acute heart failure or ischemia stroke. The secondary endpoint event was defined as 30-day cardiovascular death. Multivariate logistic regression analysis and Cox proportional hazards mode were performed to analyze the relationship between newly onset atrial fibrillation and cardiovascular adverse events, such as cardiovascular death. ResultsCompared with non-AF group, AF group had older age, higher levels of C-reactive protein, erythrocyte sedimentation rate, creatinine, troponin, SYNTAX score and GRACE score and lower levels of total cholesterol, low density lipoproteins and ejection fraction (P<0.01). In the multivariate logistic regression analysis model, newly onset atrial fibrillation, age, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, admission creatinine level, fasting blood glucose, and coronary SYNTAX score were all independent risk factors associated with higher risks of 30-day cardiovascular death (OR=1.983, 95% CI=1.036-3.795, P=0.04). Using Cox proportional hazards mode, newly onset atrial fibrillation following primary PCI was associated with long-term clinical adverse cardiovascular event (HR=1.983, 95% CI=1.036-3.795, P=0.04) after adjusting all covariates. The area under the ROC curve for combined prediction mode with GRACE score and newly onset AF was comparable to the one for the model with GRACE score alone (0.788 vs 0.767，P=0.08).ConclusionNewly onset atrial fibrillation in STEMI patients with multivessel disease who underwent emergency PCI is associated with 30-day cardiovascular death and long-term clinical adverse cardiovascular events. However, newly onset atrial fibrillation does not increase the predictive value of GRACE score.
ABSTRACT
Objective To explore the influence factors of poor myocardial perfusion in patients with ST-segment elevation myocardial infarction( STEMI) after primary percutaneous coronary intervention(PCI). Methods One hundred and forty-three patients with first STEMI who were on admission from April 2010 to May 2014 and underwent primary PCI within 12 hours were enrolled as our subjects. According to the sum-ST-segment resolution(sumSTR)and TIMI myocardial perfusion grade(TMP)after primary PCI,all patients were divided into well myocardial perfusion group( sumSTR ≥ 50% or TMP 2 - 3 grade)and poor myocardial perfusion group(sumSTR < 50% and TMP 0 - 1 grade). The influence factors between two groups were collected and analyzed,including sex,age,pain to balloon time,blood pressure on admission,left ventricular ejection fraction,leucocyte count,neutrophil ratio(NR),high-sensitivity C-reactive protein(hs-CRP),blood lipid,and the history of hypertension,diabetes mellitus. Results The leucocytes count,NR,hs-CRP in patients of poor myocardial perfusion group were(11. 60 ± 3. 57)× 109 / L,0. 84 ± 0. 06 and 9. 80 ± 11. 37 mg/ L,higher than those in well myocardial perfusion group((9. 51 ± 2. 59)× 109 / L,0. 77 ± 0. 11 and(3. 83 ± 5. 58)mg/ L),and the differences were significant(t = 3. 497,P = 0. 001;t = 3. 390,P = 0. 001;t = 3. 973,P < 0. 001). Multiple linear regression analysis showed that neutrophil ratio was independent risk factor of sumSTR in STEMI patient after primary PCI(P = 0. 000). Conclusion The increase of leucocyte count,NR and hs-CRP are related to the poor myocardial perfusion after primary PCI. The increase of neutrophil ratio is an independent risk factor of poor myocardial perfusion.