[1]杨志浩 付超 尤阳 刘子华 赵鑫.急性A型主动脉夹层患者术后新发心房颤动危险因素的回顾性队列研究[J].心血管病学进展,2024,(10):928.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.013]
 YANG Zhihao,FU Chao,YOU Yang,et al.Risk Factors for Postoperative New-Onset Atrial Fibrillation in Acute Type A Aortic Dissection Patients: A Retrospective Cohort Study[J].Advances in Cardiovascular Diseases,2024,(10):928.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.013]
点击复制

急性A型主动脉夹层患者术后新发心房颤动危险因素的回顾性队列研究()
分享到:

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2024年10期
页码:
928
栏目:
论著
出版日期:
2024-10-25

文章信息/Info

Title:
Risk Factors for Postoperative New-Onset Atrial Fibrillation in Acute Type A Aortic Dissection Patients: A Retrospective Cohort Study
作者:
杨志浩 付超 尤阳 刘子华 赵鑫
(山东大学齐鲁医院心血管外科 山东大学心脏外科胸腔镜研究所,山东 济南 250012)
Author(s):
YANG ZhihaoFU ChaoYOU YangLIU ZihuaZHAO Xin
(Department of Cardiovascular Surgery,Qilu Hospital of Shandong University,Institute of Thoracoscopy in Cardiac Surgery,Shandong University,Jinan 250012,Shandong,China)
关键词:
急性A型主动脉夹层术后新发房颤危险因素列线图模型
Keywords:
Acute type A aortic dissection Risk factors Nomogram model
DOI:
10.16806/j.cnki.issn.1004-3934.2024.10.013
摘要:
目的 探讨急性A型主动脉夹层()患者经孙氏手术后新发房颤(POAF)的危险因素,构建列线图预测模型并进行验证。方法 纳入2018年1月1日2022年12月31日期间,在齐鲁医院接受孙氏手术的患者,并将患者分为POAF组和non-POAF组,比较两组患者的临床资料。使用R语言构建列线图并验证模型的预测能力。结果 本次研究中共入组238例患者,其中POAF患者42例(17.65%)。年龄(OR1.039,95% CI 1.007~1.071,P=0.017)、左心房直径(OR1.069,95% CI 1.007~1.136,P=0.029)、右心房直径(OR1.063,95% CI 1.006~1.124,P=0.029)、术前红细胞计数(OR0.438,95% CI 0.230~0.833,P=0.012)和既往急性冠脉综合征(OR7.445,95% CI 2.869~19.321,P<0.01)是POAF的独立影响因素。预测模型ROC的是0.786。重复Boot-strap自抽样及内部验证过程1 000次,生成了ROC曲线,得出的为0.808(95% CI 0.8060.810)校准曲线可见拟合度良好。决策曲线分析显示模型有较高预测价值。结论 患者POAF风险预测模型可协助临床医师筛选高危人群,为临床决策提供参考。
Abstract:
Objective To investigate the risk factors for postoperative new-onset atrial fibrillation (POAF) in patients with acute type A aortic dissection (ATAAD) who underwent Sun’s procedure,and to construct and validate a nomogram prediction model. Methods Patients with ATAAD who underwent Sun’s procedure at Qilu Hospital from January 1,2018 to December 31,2022 were included in the study. They were divided into two groups: the POAF group and the non-POAF group. Clinical data were compared between the two groups. The nomogram was constructed and its predictive ability validated using R software. Results A total of 238 patients were included in the study,with 42 patients (17.65%) developing POAF. Age(OR1.039,95% CI 1.007~1.071,P=0.01)left atrial diameter(OR1.069,95% CI 1.007~1.136,P=0.029)right atrial diameter(OR1.063,95% CI 1.006~1.124,P=0.029)preoperative red blood cells(OR0.438,95% CI 0.230~0.833,P=0.012)and previous acute coronary syndrome emerged(OR7.445,95% CI 2.869~19.321,P<0.01)as independent influences on POAF following Sun’s surgery. The area under the ROC curve (AUC) for the predictive model was 0.786. Validation of the model through bootstrapping (1 000 repetitions) yielded an AUC of 0.80895% CI 0.806~0.810),affirming its robustness. Decision curve analysis demonstrated high predictive value of the model. Conclusion The risk prediction model for POAF in patients with ATAAD can assist clinicians in identifying high-risk populations and provide a reference for clinical decision-making

参考文献/References:

[1] Li SWei D,Wang Z,et al. Effect on surgery outcomes owing to the interval between onset of symptoms and surgery of patients with acute type A aortic dissection[J]. Emerg Crit Care Med,2022,2(2):67-72.
[2] Ma WG,Zheng J,Dong SB,et al. Sun’s procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection[J]. Ann Cardiothorac Surg,2013,2(5):621-628.
[3] Ma WG,Zheng J,Liu YM,et al. Dr. Sun’s procedure for type A aortic dissection: total arch replacement using tetrafurcate graft with stented elephant trunk implantation[J]. Aorta (Stamford),2013,1(1):59-64.
[4] Matsuura K,Ogino H,Matsuda H,et al. Prediction and incidence of atrial fibrillation after aortic arch repair[J]. Ann Thorac Surg,2006,81(2):514-518.
[5] Ahlsson A,Bodin L,Fengsrud E,et al. Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality[J]. Scand Cardiovasc J,2009,43(5):330-336.
[6] Ghurram A,Krishna N,Bhaskaran R,et al. Patients who develop post-operative atrial fibrillation have reduced survival after off-pump coronary artery bypass grafting[J]. Indian J Thorac Cardiovasc Surg,2020,36(1):6-13.
[7] Jagadish PS,Kirolos I,Khare S,et al. Post-operative atrial fibrillation:should we anticoagulate?[J]. Ann Transl Med,2019,7(17):407.
[8] Velioglu Y,Yuksel A. Predictors of postoperative atrial fibrillation after beating-heart coronary artery bypass surgery: is cardiopulmonary bypass a risk factor?[J]. Acta Cardiol Sin,2019,35(5):468-475.
[9] Eikelboom R,Sanjanwala R,Le ML,et al. Postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis[J]. Ann Thorac Surg,2021,111(2):544-554.
[10] Greenberg JW,Lancaster TS,Schuessler RB,et al. Postoperative atrial fibrillation following cardiac surgery:a persistent complication[J]. Eur J Cardiothorac Surg,2017,52(4):665-672.
[11] Elahi M,Hadjinikolaou L,Gali?anes M. Incidence and clinical consequences of atrial fibrillation within 1 year of first-time isolated coronary bypass surgery[J]. Circulation,2003,108(suppl 1):Ⅱ207-212.
[12] Arakawa M,Miyata H,Uchida N,et al. Postoperative atrial fibrillation after thoracic aortic surgery[J]. Ann Thorac Surg,2015,99(1):103-108.
[13] Daily PO,Trueblood HW,Stinson EB,et al. Management of acute aortic dissections[J]. Ann Thorac Surg,1970,10(3):237-247.
[14] Pape LA,Awais M,Woznicki EM,et al. Presentation,diagnosis,and?outcomes of?acute aortic dissection:17-year trends from the international registry of acute aortic dissection[J]. J Am Coll Cardiol,2015,66(4):350-358.
[15] Trimarchi S,Nienaber CA,Rampoldi V,et al. Contemporary results of surgery in acute type A aortic dissection:The International Registry of Acute Aortic Dissection experience[J]. J Thorac Cardiovasc Surg,2005,129(1):112-122.
[16] Elsayed RS,Cohen RG,Fleischman F,et al. Acute type A aortic dissection[J]. Cardiol Clin,2017,35(3):331-345.
[17] Qureshi M,Ahmed A,Massie V,et al. Determinants of atrial fibrillation after cardiac surgery[J]. Rev Cardiovasc Med,2021,22(2):329-341.
[18] Perzanowski C,Gandhi S,Pai RG. Incidence and predictors of atrial fibrillation after aortic repairs[J]. Am J Cardiol,2004,93(7):928-930.
[19] Zhao R,Wang Z,Cao F,et al. New-onset postoperative atrial fibrillation after total arch repair is associated with increased in-hospital mortality[J]. J Am Heart Assoc,2021,10(18):e021980.
[20] Hindricks G,Potpara T,Dagres N,et al. Corrigendum to: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J]. Eur Heart J,2021,42(40):4194.
[21] Liu M,Tan W,Yuan W,et al. Development and validation of a diagnostic model to predict the risk of ischemic liver injury after stanford a aortic dissection surgery[J]. Front Cardiovasc Med,2021,8:701537.
[22] Lee SH,Kang DR,Uhm JS,et al. New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft[J]. Am Heart J,2014,167(4):593-600.e1.
[23] Schnabel RB,Yin X,Gona P,et al. 50 year trends in atrial fibrillation prevalence,incidence,risk factors,and mortality in the Framingham Heart Study:a cohort study[J]. Lancet,2015,386(9989):154-162.
[24] Guo Y,Tian Y,Wang H,et al. Prevalence,incidence,and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation[J]. Chest,2015,147(1):109-119.
[25] Murphy NF,Simpson CR,Jhund PS,et al. A national survey of the prevalence,incidence,primary care burden and treatment of atrial fibrillation in Scotland[J]. Heart,2007,93(5):606-612.
[26] Rodriguez CJ,Soliman EZ,Alonso A,et al. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors:the Multi-Ethnic Study of Atherosclerosis[J]. Ann Epidemiol,2015,25(2):71-76,76.e1.
[27] Shen J,Lall S,Zheng V,et al. The persistent problem of new-onset postoperative atrial fibrillation:a single-institution experience over two decades[J]. J Thorac Cardiovasc Surg,2011,141(2):559-570.
[28] El-Shetry M,Mahfouz R,Frere AF,et al. The interplay between atrial fibrillation and acute myocardial infarction[J]. Br J Hosp Med (Lond),2021,82(2):1-9.
[29] Alasady M,Abhayaratna WP,Leong DP,et al. Coronary artery disease affecting the atrial branches is an independent determinant of atrial fibrillation after myocardial infarction[J]. Heart Rhythm,2011,8(7):955-960.
[30] de Mattia L,Brieda M,Dametto E,et al. Paroxysmal atrial fibrillation triggered by a monomorphic ventricular couplet in a patient with acute coronary syndrome[J]. Indian Pacing Electrophysiol J,2012,12(1):19-23.
[31] de Bortoli A,Shi LB,Ohm OJ,et al. Incidence and clinical predictors of subsequent atrial fibrillation requiring additional ablation after cavotricuspid isthmus ablation for typical atrial flutter[J]. Scand Cardiovasc J,2017,51(3):123-128.
[32] Quan D,Huang H,Kong B,et al. Predictors of late atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation: a meta-analysis[J]. Kardiol Pol,2017,75(4):376-385.
[33] Yamashita K,Hu N,Ranjan R,et al. Clinical risk factors for postoperative atrial fibrillation among patients after cardiac surgery[J]. Thorac Cardiovasc Surg,2019,67(2):107-116.
[34] Galv?o Braga C,Ramos V,Vieira C,et al. New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis[J]. Rev Port Cardiol,2014,33(5):281-287.
[35] Imataka K,Nakaoka H,Kitahara Y,et al. Blood hematocrit changes during paroxysmal atrial fibrillation[J]. Am J Cardiol,1987,59(1):172-173.

备注/Memo

备注/Memo:
收稿日期:2024-05-31 基金项目:山东省自然科学基金(ZR2022MH170)
更新日期/Last Update: 2024-11-01