Relationship between adverse event risk in 90d and atrial fibrillation thrombus risk score of patients with acute STEMI

Yan Zhi; Chen Yang; Wang Yan; Zhan Tao; Feng Dachao

doi:10.3969/j.issn.1674-4055.2023.08.18

Abstract：Objective To investigate the relationship between adverse event risk in 90 d and atrial fibrillation thrombus risk score of patients with acute STEMI.Methods Seven hundred forty-eight patients with acute STEMI were chosen from January 2011 to June 2021.All patients were grouped according to the CHA2DS2-VASc score,including 1 point group(182 cases),2～3 points groups(359 Cases),and 4 points and above groups(207 cases).The general data,treatment-related data,and 90dadverse events were analyzed.The Cox regression model was used to evaluate the influence of the CHA2DS2-VASc score on the risk of 90 d adverse events in patients with acute STEMI.ROC curve was drawn to calculate the CHA2DS2-VASc score and to predict the clinical efficacy of 90 d all-cause death.Results There was a significant difference in the age,sex,weight,time from onset to admission,baseline SBP,baseline pulse,Killip grade,location of myocardial infarction,baseline blood glucose related indicators,baseline hemoglobin,previous disease occurrence,the proportion of PCI treatment,the proportion of ACEI/ARB drugs,β receptor blockers and diuretics among three groups(P<0.05).There were significant differences in the incidence of all-cause mortality,recurrent myocardial infarction,cardiogenic shock,and stroke among the three groups(P<0.05).The univariate analysis of the Cox regression model showed that the CHA2DS2-VASc score was related to 90d adverse events in patients with acute STEMI(P<0.05).The model was constructed with CHA2DS2-VASc + thrombolytic therapy for myocardial infarction(TIMI)score and CHA2DS2-VASc + global register of acute coronary events(GRACE)score.The result of multivariate analysis showed that 2～3 points of CHA2DS2-VASc score was the independent risk factor for 90 d adverse events except for cardiogenic shock(P<0.05),and 4 points of CHA2DS2-VASc score or above was the independent risk factor for all 90 d adverse events(P<0.05).The ROC curve analysis showed that the AUCs of CHA2DS2-VASc score,TIMI score and GRACE score for predicting all-cause death in patients with acute STEMI were 0.78(95%CI:0.71～0.83),0.79(95%CI:0.73～0.84)and 0.79(95%CI:0.74～0.85),respectively.There was no significant difference between CHA2DS2-VASc score,TIMI score,and grace score in predicting AUC of 90 d all-cause death in patients with acute STEMI(Z=0.87,P=0.51).Conclusion The atrial fibrillation thrombus risk score(CHA2DS2-VASc score)can be independently used to predict the risk of 90dadverse events in patients with acute STEMI,and should be close to TIMI scale and GRAC scale in predicting the risk of all-cause death.