Analysis Of Risk Factors And Prognosis Of Acute Myocardial Infarction Complicated With New-onset Atrial Fibrillation Based On Propensity Score Matching Study

Objective To explore the risk factors and prognosis of acute myocardial infarction（AMI）complicated with new-onset atrial fibrillation（NOAF）.Methods Patients with AMI complicated with NOAF in our hospital from January 2017 to June 2021 were retrospectively analyzed,and divided into atrial fibrillation group（95 cases）and non-atrial fibrillation group（863 cases）according to inclusion and exclusion criteria..According to gender,age,and past medical history,propensity score matching（PSM）analysis was conducted in 1:1 ratio between patients in the AF group and non-AF group.After matching,93 patients in each group were matched.After matching,the data were analyzed by paired T test,Wilcoxon signed rank sum test,Mc Nemar test and Mc Nemar-bowker test.Then,the indicators with statistical significance were incorporated into the logistic regression model for multi-factor analysis to explore the risk factors of AMI combined with NOAF（excluding age,gender and past medical history）.In addition,the incidence of cardiovascular adverse events during hospitalization,Killip classification at discharge,and recent rehospitalization due to myocardial ischemia in patients with AMI combined with NOAF were analyzed.Kaplan-meier survival curves of AMI patients rehospitalized for myocardial ischemia within 18 months post-discharge were plotted.Results 1.Before PSM,the age of patients in the AF group was higher than that in the non-AF group[71（65,75）years vs.61（53,69）years,P<0.01],and the proportion of female patients was higher than that in the non-AF group（33.7%vs.21.6%,P<0.01）.History of coronary heart disease and smoking history were lower than those in non-AF group（12.6%vs.23%,P<0.05;53.7%vs.64.5%,P<0.05）.After PSM,there were no statistically significant differences in the history of hypertension,diabetes and stroke between the two groups（P>0.05）.2.STEMI and emergency PCI were more common in the AF group than in the non-AF group[57（61.3%）vs.16（17.2%）,P<0.01;80（86%）vs.56（60.2%）,P<0.01].Nt-pro BNP,NLR,LDLC,Ptf _V1absolute value and LAD were higher than those in non-AF group（P<0.05）,the LVEF was lower than that of the non-AF group[（51.205±11.567）%vs.（56.494±9.174）%,P<0.01].3.Multivariate regression analysis showed that Ptf _V1absolute value,Nt-pro BNP,LVEF and AMI types were removed from the model（P>0.05）,NLR,LDLC,LAD and PCI types were retained in the model（P<0.01,P<0.05,<0.05,P<0.01）;4.The incidence of adverse events in the AF group was significantly higher than that in the non-AF group（34.4%vs.14%,P<0.01）,and there was no significant difference in the incidence of central death,heart failure,malignant arrhythmia,and cardiac arrest（P>0.05）.The incidence of cardiogenic shock in the AF group was significantly higher than that in the non-AF group（20.4%vs.4.3%,P<0.01）.The proportion of patients with Killip grade III and IV at discharge in AF group（4.3%+22.6%）was higher than that in non-AF group（1.1%+5.4%）,and the difference was statistically significant（P<0.05）.The number of rehospitalized patients due to myocardial ischemia within 3 months post-discharge in the AF group was more than that in the non-AF group（9 cases vs.1case）,and the difference was statistically significant（P<0.05）.5.Kaplan-meier survival curve of rehospitalization for myocardial ischemia within 18 months post-discharge showed that the cumulative incidence of rehospitalization for myocardial ischemia within 18 months in the AF group was higher than that in the non-AF group（Log Rank:Chi square=15.973 P<0.01）.Separate analysis of recurrent ACS and CAD events:the cumulative risk of recurrent ACS and CAD within 18months of post-discharge was higher in the AF group than in the non-AF group,and the difference was statistically significant（Log Rank:chi square=5.325 P<0.05;Log Rank:chi square=11.786 P<0.01）.Conclusion 1.Emergency PCI,high NLR,high LDLC and left atrial enlargement are independent risk factors for AMI combined with NOAF.2.The incidence of cardiogenic shock was higher in patients with AMI and NOAF during hospitalization.The cumulative risk of rehospitalization due to myocardial ischemia was higher recently（within 3 months after discharge）and within 18 months after discharge.3.Absolute value of Ptf _V1,AMI classification（STEMI and NSTEMI）,NT-pro BNP and LVEF were correlated with the occurrence of NOAF in AMI patients.4.Elderly and female patients with AMI are more likely to have NOAF.