目的 探讨心房颤动(AF)合并急性心肌梗死患者行冠状动脉(冠脉)支架置入术后,发生缺血性脑卒中的危险因素.方法 采用查询电子病历方式,筛选出北京12家三级医院2009年12月至2015年1月收治的心房颤动合并急性心肌梗死并行经皮冠状动脉介入治疗(PCI)的患者,采用电话或门诊方式对患者进行定期随访.根据随访结果是否发生缺血性脑卒中分为,脑卒中组和非脑卒中组.对比分析两组患者基线资料,既往病史等情况,采用单因素及多因素分析引起缺血性脑卒中的危险因素.结果共纳入516例患者,平均随访时间(36.8±18.8)d,随访期间84例患者死亡,26例发生缺血性脑卒中,138例发生主要不良心血管事件(MACE).将相关临床资料为自变量进行赋值后进行Logistic多因素分析,结果显示急性冠脉综合征(ACS)分组[比值比(OR=4.24,95%CI:1.22~14.74 ,P=0.023]以及左房室径比值(OR=48.47,95%CI:1.15~2039.37,P=0.042)为缺血性脑卒中发生的独立危险因素.结论 心房颤动合并急性心肌梗死患者死亡率高,发生缺血性卒中的危险因素主要与ACS分组以及左房室径比值相关.
To investigate the risk factors of ischemia stroke after intracoronary stent implantation in patients with atrial fibrillation (AF) complicated by acute myocardial infarction (AMI). Methods The patients with AF complicated by AMI undergone PCI were chosen from 12 third-level hospitals in Beijing from Dec. 2009 to Jan. 2015 by applying inquiring of electronic medical records. All patients were regularly followed up by using methods of telephone or outpatient service, and then divided into stroke group and non-stroke group according to the follow-up results. The baseline data and past medical history (PMH) were compared and analyzed in 2 groups. The risk factors of ischemia stroke were analyzed by using single-factor and multi-factor analysis. Results There were totally 516 cases included with average follow-up time for (36.8±18.8) d. During the follow-up period, there were 84 cases died, 26 with ischemia stroke and 138 with major adverse cardiovascular events (MACE). The results of Logistic multi-factor analysis showed that grouping of acute coronary syndrome (ACS, OR=4.24, 95%CI: 1.22-14.74, P=0.023) and ratio of left atrioventricular diameter (OR=48.47, 95%CI: 1.15-2039.37, P=0.042) were independent risk factors of ischemia stroke. Conclusion The mortality is higher in patients with AF complicated by AMI, and the risk factors of ischemia stroke are related to ACS grouping and ratio of left atrioventricular diameter.