ICU治疗的老年急性冠脉综合征患者行急诊经皮冠状动脉介入术后新发房颤的预测因素

目的评价在我院ICU行急诊经皮冠状动脉介入(PCI)手术治疗的老年急性冠脉综合征(ACS)患者术后新发房颤(NOAF)的预测因素.方法选取2016年5月至2019年4月在泉州市第一医院老年病科ICU进行急诊PCI手术治疗的老年ACS患者440例.根据患者术后是否发生NOAF将患者分为NOAF组与非NOAF组,收集并比较两组患者人口统计学资料、合并症、病史、超声与血管造影特征、治疗情况、术前实验室指标.对患者进行6个月隧访,比较两组患者预后指标.采用多变量分析评价患者发生NOAF及6个月死亡的独立预测因素.采用受试者工作特征(ROC)曲线分析相关预测因素敏感度、特异度.结果共有77例(17.5%)发生NOAF(NOAF组,n=77),363例(82.5%)未发生NOAF(非NOAF组,n=363).68例(15.5%)死亡.多变量Logistic回归分析表明,心肌梗死(MI)病史(OR=4.510,95%CI1.680~12.107,P=0.004)与单核细胞/高密度脂蛋白比值(MHR,OR=1.103,95%CI1.055~1.153,P<0.001)是老年ACS患者急诊PCI术后发生NOAF的独立预测因素.MHR的ROC曲线下面积为0.750,MHR预测NOAF的截断值为15.873,敏感度为75.98%,特异度为65.03%.多变量Cox比例模型分析表明,NOAF(HR=2.330,95%CI2.489~8.625,P=0.019)与Killip分级Ⅲ/Ⅳ级(HR=2.951,95%CI 1.219~7.137,P=0.017)是老年ACS患者急诊PCI术后6个月死亡的独立预测因素.结论MI病史和MHR是老年ACS患者急诊PCI术后发生NOAF的独立预测因素,NOAF与Killip分级Ⅲ/Ⅳ级是老年ACS患者急诊PCI术后6个月死亡的独立预测因素.

Predictive factors of new-onset atrial fibrillation after emergency percutaneous coronary intervention in elderly patients with acute coronary syndrome treated in ICU

Objective To evaluate the predictive factors of new-onset atrial fibrillation(NOAF)in elderly patients with acute coronary syndrome(ACS)undergoing emergency percutaneous coronary intervention(PCI)in our hospital.Methods 440 elderly patients with ACS who underwent emergency PCI in Quanzhou first hospital from May 2016 to April 2019 were enrolled.The patients were Jivided into NOAF group and non-NOAF group according to whether NOAF occurred after surgery.The demographics,comorhidities,medical history,ultrasound and angiographic features,treatment status and preoperative laboratory indexes were collected and compared between the two groups.The patients were followed up for 6 months and the prognostic indicators of two groups were compared.Multivariate analysis was used to assess independent predictors of NOAF and 6-month mortality in the patients respectively.The receiver operator characteristic(ROC)curve was used to analyze the sensitivity and specificity of the relevant predictors.Results A total of 77 patients(17.5%)developed NOAF(NOAF group,n=77),and 363 patients(82.5%)did not develop NOAF(non-NOAF group,n=363).68 patients(15.5%)died.Multivariate Logistic analysis showed a history of myocardial infarction(MI)(OR=4.510,95%Cl 1.680-12.107,P=0.004)and monocyte-to-high-density lipoprotein ratio(MHR)(OR=1.103,95%CI 1.055-1.153,P<0.001)was an independent predictor of NOAF in elderly patients.The area under curve of MHR was 0.750.The MHR predicted that the cut-off value of NOAF was 15.873,the sensitivity was 75.98%,and the specificity was 65.03%.Multivariate Cox analysis showed that NOAF(HR=2.330,95%CI 2.489-8.625,P=0.019)and Kill ip gradeⅢ/Ⅳ(HR=2.951,95%Cl 1.219-7.137,P=0.017)were independent predictors of death in elderly ACS patients at 6 months after PCI.Conclusion The history of MI and MHR are independent predictors of postoperative NOAF in elderly ACS patients undergoing emergency PCI.iNOAF and Killip gradeⅢ/Ⅳare independent predictors of deathat 6 months after PCI in elderly ACS patients.