RESUMO
Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.
Assuntos
Fibrilação Atrial , Infarto do Miocárdio com Supradesnível do Segmento ST , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Proteína C-Reativa/metabolismo , Estudos Transversais , Humanos , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Ácido ÚricoRESUMO
ABSTRACT Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.
RESUMO
BACKGROUND: In patients with an acute coronary syndrome (ACS), no conclusive agreement has been reached to date regarding the association between the different types of atrial fibrillation (AF) and the in-hospital mortality risk. We conducted a retrospective cohort study in patients with ACS to determine the prognostic implications of the different types of AF. METHODS: We analyzed 6705 consecutive patients with ACS admitted to a coronary care unit (CCU), including 3094 with ST segment elevation myocardial infarction (STEMI) and 3611 with non-ST-elevation acute coronary syndrome (NSTE-ACS). We identified the patients with pre-existing AF, new-onset AF at admission, and new-onset AF at the CCU. RESULTS: The overall incidence of AF was documented in 360 (5.4%) of the patients (STEMI, 5%; NSTE-ACS, 5.6%), 140 (2.1%) of whom had pre-existing AF, and 220 (3.2%) of whom had new-onset AF (AF at admission, 1.3%; AF at the CCU, 1.9%). The patients with AF had high-risk clinical characteristics and developed major adverse events more frequently than did the patients without AF. The unadjusted in-hospital mortality risk was significantly higher in the patients with pre-existing AF (STEMI, 3.79-fold; NSTE-ACS, 3.4-fold) and AF at the CCU (STEMI, 2.02-fold; NSTE-ACS, 8.09-fold). After adjusting for the multivariate analysis, only the AF at the CCU in the NSTE-ACS group was associated with a 4.40-fold increase in the in-hospital mortality risk (odds ratio 4.40, CI 1.82-10.60, p=0.001). In the STEMI group, the presence of any type of AF was not associated with an increased risk of mortality. CONCLUSION: Among the different types of AF in patients with ACS, only the new-onset AF that developed during the CCU stay in patients with NSTE-ACS was associated with a 4.40-fold increase in the in-hospital mortality risk.