Value of remnant lipoprotein cholesterol and homocysteine in predicting new-onset atrial fibrillation in elderly patients with acute myocardial infarction

Abstract

Abstract:

ObjectiveTo investigate the value of remnant lipoprotein cholesterol（RLP-C）and homocysteine（Hcy）in predicting new-onset atrial fibrillation（AF） in elderly patients with acute myocardial infarction（AMI）.MethodsA total of 449 elderly patients with AMI admitted to the Cardiology Department of Langfang Fourth People’s Hospital from January 2018 to June 2023 were enrolled as the research objects. The patients were divided into AF group (n=90) and non-AF group (n=359) according to the occurrence of new-onset AF during hospitalization. The clinical data of the two groups were collected. Logistic regression was used to analyze the risk factors of new-onset AF, and receiver operating characteristic (ROC) curve was used to judge the predictive effect of each index on new-onset AF.ResultsCompared with the non-AF group, the heart rate on admission, RLP-C and Hcy levels in the AF group were increased (P<0.05). There were significant differences in Killip grades between the two groups (P<0.05). Logistic regression analysis showed that heart rate on admission, RLP-C and Hcy were independent risk factors for new-onset AF (P<0.05). ROC curve analysis showed that the AUC of RLP-C, Hcy and their combination in predicting new-onset AF in elderly patients with AMI were 0.761, 0.720 and 0.845, respectively. The AUC of RLP-C and Hcy combined prediction was higher than that of single prediction (Z=3.061, 3.692,P<0.05).ConclusionsRLP-C and Hcy are independent predictors of new-onset AF in elderly patients with AMI. The combination of RLP-C and Hcy can further improve the predictive value.

Key words:New-onset atrial fibrillation,Acute myocardial infarction,Remnant lipoprotein cholesterol,Homocysteine,Old age,ROC curve,Prediction

CLC Number:

R542.22

LI Qing, ZHENG Zhaoxia, LUO Jinghui, LI Li, NIU Fuying. Value of remnant lipoprotein cholesterol and homocysteine in predicting new-onset atrial fibrillation in elderly patients with acute myocardial infarction[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(01): 68-71.

Figures/Tables4

Table 1

Comparison of clinical data between the two groups [n(%)/$\bar{x}±s$M(Q1, Q3)]

临床资料	房颤组（n=90）	非房颤组（n=359）	P
男性	48（53.3）	209（58.2）	0.495
年龄（岁）	70.16±5.96	68.73±5.11	0.593
吸烟史 [n(%)]	31(34.4)	154(42.90)	0.099
入院时收缩压（mmHg）	123.91±20.65	128.53±26.31	0.094
入院时心率（次/min）	86.30±21.26	76.60±18.69	0.001 0.321 0.765
高血压 [n(%)]	66(73.3)	240(66.9)
糖尿病 [n(%)]	29(32.2)	126(35.1)
脑卒中 [n(%)]	24(26.7)	79(22.0)	0.311
白细胞计数(×10⁹/L）	9.98±3.41	9.59 ±3.28	0.753
中性粒细胞计数（×10⁹/L)	7.90±3.17	7.51±3.10	0.551
淋巴细胞计数（×10⁹/L）	1.50±1.15	1.71±1.20	0.173
血红蛋白（g/L）	129.08±17.35	135.43±19.68	0.086
血小板计数（×10⁹/L）	211.09±69.02	217.37±70.08	0.905
TC（mmol/L）	4.41（3.79，5.10）	4.15（3.65，4.89）	0.072
TG（mmol/L）	1.92（1.20，2.51）	1.79（1.07，2.10）	0.054
HDL-C（mmol/L）	0.98（0.81,1.29）	1.14（0.86，1.30）	0.097
LDL-C（mmol/L）	2.63（2.10，3.21）	2.35（1.93，2.88）	0.090
RLP-C（mmol/L）	0.80（0.53，1.22）	0.65（0.36，0.87）	<0.001
Hcy（μmol/L）	17.87±2.31	11.99±2.00	<0.001
LVEDD（mm）	48.06±4.20	46.30±3.71	0.082
LA（mm）	39.53±4.19	36.79±4.03	0.071
LVEF（%）	49.29±11.23	52.39±12.08	0.065
心功能Killip分级 [n(%)]			<0.001
Ⅰ级	34（37.8）	201（56.0）
Ⅱ级	32（35.6）	119（33.1）
Ⅲ级	18（20.0）	30（8.4）
Ⅳ级	6（6.6）	9（2.5）
β受体阻滞剂 [n(%)]	51(56.7)	241(67.1)	0.094
ACEI/ARNI [n(%)]	46(51.1)	210(58.5)	0.401

Table 1

项目	β	SE	Waldχ²	P	OR	95% CI
入院时心率	1.961	0.518	7.453	0.006	3.659	1.430~7.011
RLP-C	1.765	0.471	8.334	0.003	3.698	1.465~8.653
Hcy	1.067	0.406	5.730	0.010	2.027	1.170~5.390

Table 2

指标	最佳截断值	灵敏度（%）	特异度（%）	AUC	95% CI
RLP -C	0.78 mmol/L	73.91	80.07	0.761	0.709~0.820
Hcy	15.35 μmol/L	68.12	76.45	0.720	0.671~0.745
联合	/	81.16	85.87	0.845	0.761~0.902

Table 3

Figure 1

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