Perm Medical JournalPerm Medical JournalПермский медицинский журнал (сетевое издание "Perm medical journal")0136-14492687-1408Eco-Vector70743610.17816/pmj432116-131Original studiesОригинальные исследованияResearch ArticleEffect of atrial fibrillation paroxysm during ST-segment elevation myocardial infarction on the prognosis of patients under long-term follow-upВлияние пароксизма фибрилляции предсердий при развитии инфаркта миокарда с подъемом сегмента ST на прогноз больных при длительном наблюденииhttps://orcid.org/0009-0007-5352-0666SafarovE. N.СафаровЭ. Н.
Russian Federation

Postgraduate Student, Department of Internal Medicine and Cardiology

аспирант кафедры внутренних болезней и кардиологии

nakoziolova@mail.ruhttps://orcid.org/0009-0000-4834-2905KoryaginV. S.КорягинВ. С.
Russian Federation

Resident, Department of Internal Medicine and Cardiology

ординатор кафедры внутренних болезней и кардиологии

nakoziolova@mail.ruhttps://orcid.org/0000-0001-7003-5186KoziolovaN. A.КозиоловаН. А.
Russian Federation

DSc in Medicine, Professor, Head, Department of Internal Medicine and Cardiology

доктор медицинских наук, профессор, заведующая кафедрой внутренних болезней и кардиологии

nakoziolova@mail.ruhttps://orcid.org/0000-0002-3694-3647PolyanskayaE. A.ПолянскаяЕ. А.
Russian Federation

DSc in Medicine, Professor, Department of Internal Medicineand Cardiology

доктор медицинских наук, профессор кафедры внутренних болезней и кардиологии

nakoziolova@mail.ruYe.A. Vagner Perm State Medical UniversityПермский государственный медицинский университет имени академика Е.А. Вагнера140520264321161311405202614052026Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-Вектор2026Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://permmedjournal.ru/PMJ/article/view/707436

Objective. To evaluate the impact of paroxysmal atrial fibrillation (AF) during the development of ST segment elevation myocardial infarction (MI) on the prognosis of patients during long-term follow-up.

Materials and methods. The study presents the results of the second stage (outpatient) of a prospective, two-stage, open-label, observational clinical trial. To assess the contribution of AF to the unfavorable prognosis of patients with ST-segment elevation MI, patients were divided into two groups. The first group included 42 patients (36.8 %) with ST-segment elevation MI without AF during hospitalization and in their medical history; the second group included 72 patients (63.2 %) with ST-segment elevation MI and paroxysmal AF during the index hospitalization for MI. To register an unfavorable prognosis, primary endpoints were determined - cardiovascular death associated with the development of recurrent MI, acute decompensation of chronic heart failure (ADHF), acute cerebrovascular accident (ischemic, hemorrhagic strokes, intracerebral hemorrhage, acute brain circulation disorders), as well as secondary endpoints: fatal recurrent MI, ADHF, stroke.

Results. The follow-up duration was 22.2 ± 4.5 months from the first day of the index hospitalization with ST-segment elevation MI. During the follow-up, permanent AF was registered in 12 (16.7 %) patients of the second group, persistent/paroxysmal AF was registered in 35 (48.6 %), and recurrent paroxysms were not registered in 25 (49.0 %) of 51 patients with newly diagnosed AF during ST-segment elevation MI. In the first group, AF was newly diagnosed in 4 (9.5 %) patients during the follow-up. During 2 years of follow-up, the incidence of the primary endpoint was statistically significantly higher in the group of patients with AF (p = 0.004), as were the number of patients with a fatal outcome (p = 0.004) and the incidence of fatal stroke (p = 0.020). In case of paroxysmal AF development in patients with ST-segment elevation MI during index hospitalization, the OR of fatal events during 2 years of observation increases by 3.877 times (95 % CI 1.508–10.195), RR – by 2.399 (95 % CI 1.285–4.941), the OR of the frequency of fatal events increases by 4.021 times (95 % CI 1.518–10.946), RR – by 2.553 times (95 % CI 1.305–5.569), the OR of cardiovascular death – by 4.334 times (95 % CI 1.095–19.951), RR – by 3.501 (95 % CI 1.077–14.636), the OR of fatal stroke – by 1.388 (95 %CI 1.367–1.442), RR – 1.328 (95 %CI 1.265–1.396). Univariate analysis showed that the development of paroxysmal AF during the index hospitalization with ST-segment elevation MI increased the Odds ratio of CV death developing during 2 years of follow-up by 3.637 times (95 % CI 1.071–12.351, p = 0.038). The incidence of fatal recurrent MI and ADHF did not differ between the groups.

Conclusions. During a two-year follow-up, 48.6 % of patients who had a STEMI and an episode of AF died from cardiovascular causes, which is 2.5 times higher than among those without rhythm disturbances (19.0 %) (p = 0.004). The development of paroxysmal AF during the index hospitalization with ST-segment elevation MI increases the odds ratio for the development of cardiovascular death over 2 years of follow-up by 3.637 times. The main cause of death in patients who had a STEMI with an episode of AF was stroke, the OR of which increased by 1.388 times, and the RR of which increased by 1.328 times. The incidence and timing of fatal recurrent MI and ADHF were not associated with paroxysmal AF in patients with ST-segment elevation MI.

Цель. Оценить влияние пароксизма фибрилляции предсердий (ФП) при развитии инфаркта миокарда (ИМ) с подъемом сегмента ST на прогноз больных при длительном наблюдении.

Материалы и методы. Представлены результаты второго этапа (амбулаторного) проспективного двухэтапного открытого наблюдательного клинического исследования. Для оценки вклада ФП в неблагоприятный прогноз для больных ИМ с подъемом сегмента ST обследованных разделили на две группы: в первую группу включили 42 пациента (36,8 %) с ИМ с подъемом сегмента ST без ФП во время госпитализации и в анамнезе, во вторую группу – 72 больных (63,2 %) с ИМ с подъемом сегмента ST и пароксизмом ФП во время индексной госпитализации с ИМ. Для регистрации неблагоприятного прогноза определялись первичная конечная точка – сердечно-сосудистая смерть, связанная с развитием повторного ИМ, острой декомпенсации хронической сердечной недостаточности (ОДСН), острого нарушения мозгового кровообращения (ОНМК) (ишемические, геморрагические инсульты, внутримозговое кровоизлияние), а также вторичные конечные точки: фатальные повторный ИМ, ОДСН, ОНМК.

Результаты. Длительность наблюдения составила 22,2 ± 4,5 мес. от первого дня индексной госпитализации с ИМ с подъемом сегмента ST. За время наблюдения у 12 (16,7 %) больных второй группы была зарегистрирована постоянная форма ФП, у 35 (48,6 %) – персистирующая/пароксизмальная, у 25 (49,0 %) из 51 пациента с впервые выявленной ФП во время ИМ с подъемом сегмента ST – повторных пароксизмов не было зарегистрировано. В первой группе за время наблюдения у 4 (9,5 %) пациентов зафиксирована впервые выявленная ФП. В течение двух лет наблюдения частота развития первичной конечной точки была статистически значимо выше в группе пациентов с ФП (p = 0,004), как и число больных со смертельным исходом (p = 0,004), и частота развития фатального ОНМК (p = 0,020). При развитии пароксизма ФП у больных во время индексной госпитализации с ИМ с подъемом сегмента ST ОШ развития смертельных событий в течение двух лет наблюдения увеличивается в 3,877 раза (95 % ДИ 1,508–10,195), ОР – в 2,399 (95 % ДИ 1,285–4,941), ОШ частоты встречаемости смертельных событий возрастает в 4,021 раза (95 % ДИ 1,518–10,946), ОР – в 2,553 раза (95 % ДИ 1,305–5,569), ОШ развития сердечно-сосудистой смерти – в 4,334 раза (95 % ДИ 1,095–19,951), ОР – в 3,501 (95 % ДИ 1,077–14,636), ОШ развития фатального ОНМК – в 1,388 (95 % ДИ 1,367–1,442), ОР – в 1,328 (95 % ДИ 1,265–1,396). Однофакторный анализ показал, что развитие пароксизма ФП во время индексной госпитализации с ИМ с подъемом сегмента ST увеличивает ОР развития сердечно-сосудистой смерти в течение двух лет наблюдения в 3,637 раза (95 % ДИ 1,071–12,351, p = 0,038). Частота смертельных повторных ИМ и ОДСН не различалась между группами.

Выводы. За двухлетний период наблюдения среди перенесших ИМ с подъемом сегмента и эпизодом ФП умерло от сердечно-сосудистых причин 48,6 % пациентов, в 2,5 раза больше, чем среди обследуемых без нарушений ритма (19,0 %) (p = 0,004). Развитие пароксизма ФП во время индексной госпитализации с ИМ с подъемом сегмента ST увеличивает ОР развития сердечно-сосудистой смерти в течение двух лет наблюдения в 3,637 раза. Основной причиной смертельных исходов у больных, перенесших ИМ с подъемом сегмента с эпизодом ФП, явилось ОНМК, ОШ развития которого увеличивается – в 1,388 раза, ОР в 1,328 раза. Частота и время наступления фатальных повторных ИМ и ОДСН не были связаны с пароксизмом ФП у больных ИМ с подъемом сегмента ST.

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