Baseline characteristics of AMI patients
The subjects were composed of 186 males (84.9%) and 33 females (15.1%). The youngest patient was 24 years old, whereas the oldest was 79 (mean age 58.32 ± 10.83 years). Of the 219 patients assessed, 24 (11.0%) developed AA, including 16 patients (7.3%) with AF, 1 patient (0.5%) with atrial tachycardia, and 7 patients (3.2%) with frequent PACs > 200/24 h. The type of AF that patients had were all paroxysmal AF and terminated either naturally or with the administration of amiodarone. No patients developed ventricular arrhythmias during the monitoring period. The clinical and biochemical characteristics of AA and non-AA groups are summarized in Table
1.
Table 1
Baseline characteristics
Clinical characteristics |
Age, years | 65.25 ± 9.98 | 57.47 ± 10.78 | 0.001 |
Gender, males | 19 (79.17) | 167 (85.64) | 0.403 |
Weight, kg | 69.52 ± 7.64 | 75.31 ± 9.95 | 0.007 |
Heart rate on admission, (per min) | 74.79 ± 12.33 | 77.78 ± 12.00 | 0.252 |
SBP on admission, mmHg | 122.75 ± 25.20 | 127.75 ± 19.63 | 0.256 |
AMI type |
STEMI | 14 (58.33) | 126 (64.62) | 0.545 |
NSTEMI | 10 (41.67) | 69 (35.38) | 0.545 |
Killip classification |
I | 12 (50) | 103 (52.82) | 0.794 |
II | 7 (29.17) | 85 (43.59) | 0.177 |
III | 3 (12.5) | 5 (2.56) | 0.014 |
IV | 2 (8.33) | 2 (1.03) | 0.012 |
Patients with history of hypertension | 13 (54.17) | 102 (52.31) | 0.863 |
Patients with history of diabetes mellitus | 9 (37.5) | 63 (32.31) | 0.609 |
Patients with history of hyperlipidemia | 44 (22.56) | 5 (20.83) | 0.848 |
Patients with history of previous myocardial infarction | 6 (25) | 30 (15.38) | 0.230 |
Patients with history of stroke | 3 (12.5) | 22 (11.28) | 0.859 |
Family members with premature cardiovascular disease | 12 (50) | 68 (34.87) | 0.084 |
Use of β-blockers | 11 (45.83) | 135 (69.23) | 0.022 |
Use of ACEI/ARB | 4 (16.67) | 82 (42.05) | 0.016 |
Echocardiography |
LAAPd, mm | 38.46 ± 5.12 | 37.31 ± 21.94 | 0.799 |
LVDd, mm | 50.29 ± 4.15 | 47.83 ± 4.08 | 0.006 |
LVSd, mm | 36.04 ± 5.95 | 32.13 ± 5.48 | 0.001 |
LVEF, % | 50.83 ± 12.62 | 59.16 ± 10.57 | < 0.001 |
Biochemical characteristics |
Hemoglobin, g/L | 133.33 ± 16.41 | 140.76 ± 24.02 | 0.143 |
Total cholesterol, mmol/L | 4.02 ± 0.94 | 4.59 ± 1.13 | 0.018 |
HDL, mmol/L | 0.97 ± 0.29 | 0.95 ± 0.22 | 0.615 |
LDL, mmol/L | 2.50 ± 1.09 | 3.03 ± 0.99 | 0.016 |
cTnI, ng/mL | 81.41 ± 115.33 | 92.10 ± 121.38 | 0.683 |
BNP, pg/mL | 1177.6 ± 1269.00 | 218.34 ± 348.10 | < 0.001 |
Creatinine, μmol/L | 112.45 ± 117.84 | 70.13 ± 23.31 | < 0.001 |
Hs-CRP, mg/L | 39.74 ± 43.50 | 12.22 ± 19.25 | < 0.001 |
ESR, mm/h | 15.29 ± 14.98 | 16.72 ± 59.95 | 0.914 |
TSP-1, μg/mL | 29.01 ± 25.87 | 18.36 ± 10.89 | < 0.001 |
Patients with AA tended to be older compared with patients without AA (65.25 ± 9.98 vs 57.47 ± 10.78 years, p = 0.001). No significant differences were observed between the two groups regarding gender, heart rate, and systolic blood pressure (SBP) on admission, AMI type, previous hypertension history, diabetes mellitus, hyperlipidemia, myocardial infarction, stroke, and family history of coronary heart disease (p > 0.05).
Data showed worse heart functions in patients with AA. Patients with AA had higher Killip levels (Killip III: 12.5% vs 2.56%, p = 0.014, Killip IV: 8.33% vs 1.03%, p = 0.012), higher brain natriuretic peptide (BNP) levels (1177.67 ± 1269.00 pg/mL vs 218.34 ± 348.10 pg/mL, p < 0.001), larger LVDd (50.29 ± 4.15 mm vs 47.83 ± 4.08 mm, p = 0.006) and LVSd (36.04 ± 5.95 mm vs 32.13 ± 5.48 mm, p = 0.001), and lower LVEF (50.83% ± 12.62% vs 59.16% ± 10.57%, p < 0.001). On the other hand, no significant differences were observed in the LAAPd (p > 0.05) since all patients had no previous arrhythmias. Patients with AA also used fewer β-blockers (45.83% vs 69.23%, p = 0.022) and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II type I receptor blockers (ARBs) (16.67% vs 42.05%, p = 0.016) probably because of worse acute cardiac conditions.
Patients with AA also had lower total cholesterol (4.02 ± 0.94 mmol/L vs 4.59 ± 1.13 mmol/L, p = 0.018), lower low-density lipoprotein (LDL, 2.50 ± 1.09 mmol/L vs 3.03 ± 0.99 mmol/L, p = 0.016), and lower body weights (69.52 ± 7.64 kg vs 75.31 ± 9.95 kg, p = 0.007). No significant difference in high-density lipoprotein (HDL) was observed between the groups (p > 0.05).
Patients with AA had higher creatinine levels (112.45 ± 117.84 μmol/L vs 70.13 ± 23.31 μmol/L, p < 0.001) than patients without AA, whereas no differences were observed in hemoglobin and cardiac troponin I (cTnI) levels (p > 0.05).
The plasma TSP-1 levels (29.01 ± 25.87 μg/mL vs 18.36 ± 10.89 μg/mL, p < 0.001) were significantly higher in patients with AA than patients without. High sensitivity-C reactive protein (Hs-CRP, 39.74 ± 43.50 mg/L vs 12.22 ± 19.25 mg/L, p < 0.001) was also higher in AA patients. No differences in erythrocyte sedimentation rate (ESR) levels were observed between the groups (p > 0.05).
Multivariate logistic regression reveals TSP-1 as an independent risk factor for newly onset atrial arrhythmias
Univariate analysis for AA risk assessment was performed for the significantly different variables mentioned above. A multivariate logistic regression model was built to find risk factors for AA. As shown in Table
2, TSP-1 (OR 1.042; 95% CI 1.013–1.072,
p = 0.004), age (OR 1.091; 95% CI 1.033–1.153,
p = 0.002), Hs-CRP (OR 1.027; 95% CI 1.012–1.043,
p = 0.001), and LVDd (OR 1.142; 95% CI 1.018–1.282,
p = 0.024) emerged as independent risk factors for AA after adjusting for other potential risk factors.
Table 2
Factors independently associated with newly onset AA in AMI patients
TSP-1 | 1.041 | 1.013–1.069 | 0.003 | 1.042 | 1.013–1.072 | 0.004 |
Age | 1.083 | 1.031–1.132 | 0.001 | 1.091 | 1.033–1.153 | 0.002 |
Hs-CRP | 1.029 | 1.016–1.042 | 0.000 | 1.027 | 1.012–1.043 | 0.001 |
LVDd | 1.150 | 1.038–1.273 | 0.007 | 1.142 | 1.018–1.282 | 0.024 |
LVEF | 0.937 | 0.902–0.927 | 0.001 | | | |
BNP | 1.001 | 1.000–1.002 | 0.001 | | | |
Killip level | 1.734 | 0.979–3.072 | 0.059 | | | |
Creatinine | 1.014 | 1.003–1.024 | 0.008 | | | |
Weight | 0.931 | 0.885–0.980 | 0.006 | | | |