预后营养指数及CHA2DS2-VASc评分对急性ST段抬高型心肌梗死患者院内新发心房颤动的预测价值OACSTPCD

Objective To investigate the predictive value of the prognostic nutritional index(PNI)and CHA2DS2-VASc score for in-hospital new-onset atrial fibrillation(NOAF)in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 290 STEMI patients who underwent PCI during hospitalization in the department of cardiovascular medicine of Zhejiang Provincial People's Hospital from March 2019 to October 2020 were enrolled.Patients were divided into the NOAF group and the non-NOAF group based on the occurrence of NOAF.Demographic characteristics and clinical data of patients in the two groups were collected and compared.Binary multivariate Logistic stepwise regression analysis was used to indentify influencing factors for in-hospital NOAF.Receiver operating characteristic(ROC)curve was performed to analyze the predictive value of CHA2DS2-VASc score combined with PNI for NOAF in STEMI patients.Results Thirty-eight patients(13.1%)developed NOAF during hospitalization.Univariate analysis showed that age,serum creatinine(Scr),high-sensitivity C-reactive protein(hs-CRP),B-type natriuretic peptide(BNP),left atrial diameter(LAD),CHA2DS2-VASc score,Killp classificationⅢand Ⅳ,proportion of diabetes,and proportion of left circumflex artery stenosis in the NOAF group were higher than those in the non-NOAF group.Weight,body mass index(BMI),systolic blood pressure,diastolic blood pressure,albumin,total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),estimated glomerular filtration rate(eGFR),lymphocyte count,left ventricular ejection fraction(LVEF),and PNI in the NOAF group were lower than those in the non-NOAF group.Differences were statistically significant(t/Z/χ2=8.004,-2.712,-4.023,-6.535,3.636,-5.937,-8.813,5.930,6.036,-7.083,-9.795,-2.130,-2.783,-4.653,-2.852,-2.274,-4.813,-4.684,-5.773,-6.344;P<0.05).Binary multivariate Logistic stepwise regression analysis showed that BMI,LAD,LVEF,CHA2DS2-VASc score,left circumflex artery stenosis,and PNI were influence factors for in-hospital NOAF after PCI in STEMI patients(OR=0.484,1.183,0.905,1.534,9.594,0.885;P<0.05).ROC curve analysis showed that the area under the curve(AUC)of combination of CHA2DS2-VASc score and PNI in predicting in-hospital NOAF in STEMI patients after PCI was 0.867,which was higher than those of individual indicators(ZCHA2DS2-VASc=2.581,ZPNI=2.252).Conclusion CHA2DS2-VASc score combined with PNI has a high predictive value for in-hospital NOAF in STEMI patients,and can be used for early screening of high-risk patients.