Impact of left atrial diameter on all-cause mortality of patients with STEMI undergoing primary percutaneous coronary intervention

Kai Wang; Deli Zeng; Zijun Chen; Wei Yu

doi:10.15537/smj.2023.44.12.20230235

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Figure 1
- Adjusted cubic spline model of the association between left atrial diameter and risk of all-cause mortality (A) and risk of major cardiovascular events (B).
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Figure 2
- Odd ratios and error bars delineating 95% confidence intervals from Model 3 by subgroups. Multiplicative interaction terms for each subgroup were performed, gender subgroup and left ventricular ejection fraction subgroup were statistically significant (p<0.05).
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Figure 3
- Receiver operating characteristic curves of LAd, valuable variables (including age, gender, hypertension, diabetes, WBC, Hb, albumin, cTnI and BNP), LAd plus valuable variable for predicting all-cause mortality (A) and major cardiovascular events(B).

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Table 1

- Baseline characteristics of study participants according to the left atrial diameter quartiles.

Parameters	All (LAd from 21 to 78 mm) (n=633)	Q1 (LAd from 21 to 31 mm) (n=188)	Q2 (LAd from 32 to 38mm) (n=131)	Q3 (LAd from 39 to 48mm) (n=151)	Q4 (LAd from 49 to 78mm) (n=163)	P-value
Female, n (%)	182 (28.8)	54 (28.7)	26 (19.8)	57 (37.7)	45 (27.6)	0.011
Age (years), n (%)	65.68 (11.98)	65.8 (11.9)	64.0 (12.3)	66.5 (11.5)	66.2 (12.2)	0.296
Smoking, n (%)	388 (61.3)	117 (62.2)	94 (71.8)	82 (54.3)	95 (58.3)	0.020
Hypertension, n (%)	343 (54.2)	99 (52.7)	89 (67.9)	83 (55)	72 (44.2)	<.001
Diabetes, n (%)	139 (22.0)	39 (20.7)	38 (29)	37 (24.5)	25 (15.3)	0.034
WBC (×10⁹/L)	10.60 (4.42)	10.5 (4.2)	10.7 (3.7)	10.5 (5.0)	10.7 (4.6)	0.915
Hb (g/L)	132.86 (20.31)	134.8 (19.0)	136.5 (21.5)	128.2 (20.6)	132.0 (19.9)	0.003
PLT ((×10⁹/L)	198.29 (67.83)	207.1 (64.5)	204.4 (70.7)	193.4 (64.0)	187.7 (71.3)	0.029
CRP (mg/L)	20.95 (41.76)	15.7 (31.5)	22.4 (42.9)	19.4 (44.5)	27.3 (47.7)	0.066
ALT (U/L)	63.98 (136.51)	59.5 (169.8)	79.8 (180.8)	59.9 (61.2)	60.1 (97.3)	0.527
AST (U/L)	186.06 (248.76)	161.5 (237.8)	225.6 (361.2)	195.7 (184.9)	173.7 (193.8)	0.123
TP (g/L)	65.07 (28.63)	70.3 (51.1)	64.6 (6.7)	62.9 (7.2)	61.5 (7.2)	0.021
Albumin (g/L)	38.97 (5.20)	39.0 (5.2)	38.7 (5.9)	39.3 (5.3)	38.8 (4.4)	0.718
Urea (mean (SD))	6.92 (3.16)	6.5 (2.5)	6.7 (2.6)	7.1 (3.5)	7.3 (3.8)	0.067
UA (mean (SD))	347.95 (117.89)	344.3 (105.9)	365.3 (120.1)	352.0 (120.8)	334.5 (125.4)	0.149
Cr (umol/L)	88.16 (51.83)	81.6 (41.4)	88.5 (50.1)	90.5 (52.5)	93.3 (62.1)	0.180
TC (mmol/L)	4.55 (1.20)	4.6 (1.2)	4.6 (1.1)	4.5 (1.2)	4.5 (1.3)	0.748
TG (mmol/L)	1.56 (1.00)	1.6 (1.0)	1.6 (0.9)	1.6 (1.1)	1.5 (1.0)	0.509
HDL-C (mmol/L)	1.17 (0.43)	1.2 (0.6)	1.2 (0.4)	1.2 (0.3)	1.1 (0.3)	0.736
LDL-C (mmol/L)	2.74 (0.95)	2.7 (0.9)	2.7 (0.9)	2.8 (1.0)	2.8 (1.0)	0.536
Glucose (mmol/L)	8.00 (4.98)	7.7 (5.3)	8.6 (5.6)	8.3 (4.6)	7.6 (4.4)	0.236
HbA1c	6.44 (1.59)	6.5 (1.6)	6.4 (1.6)	6.5 (1.7)	6.3 (1.4)	0.68
cTnI (ng/ml)	13.74 (20.74)	13.9 (21.1)	17.3 (23.8)	14.4 (24.0)	10.0 (12.3)	0.023
CK-MB (U/L)	85.38 (169.41)	79.2 (215.8)	82.2 (168.7)	76.4 (110.7)	103.4 (153.6)	0.462
BNP (pg/ml)	2893.54 (4710.81)	2793.7 (4467.8)	2714.5 (5100.7)	3295.8 (5655.5)	2779.9 (3583.1)	0.690
LV (mm)	42.01 (9.31)	46.4 (5.7)	49.1 (6.4)	38.3 (11.1)	34.6 (4.9)	<0.001
RA (mm)	27.62 (7.43)	32.3 (3.4)	33.1 (4.3)	24.4 (8.3)	20.8 (4.2)	<0.001
RV (mm)	15.33 (5.32)	19.3 (2.4)	19.4 (2.6)	12.7 (5.4)	10.0 (2.2)	<0.001
LVEF	56.85 (12.58)	59.3 (9.8)	55.4 (11.7)	57.9 (13.9)	54.3 (14.2)	<0.001
All-cause mortality, n (%)	108 (17.1)	9 (4.8)	14 (10.7)	29 (19.2)	56 (34.4)	<0.001

Values are presented as mean ± standard deviation, median. ALT: alanine aminotransferase, AST: aspartate aminotransferase, BNP: B-type natriuretic peptide, CK-Mb: creatin kinase isoenzyme MB, CRP: C-reactive protein, cTnI: cardiac troponin I, Cr: creatinine, WBC: white blood cell count, Hb: hemoglobin, PLT: platelets, TP: total albumin, UA: uric acid, TC: total cholesterol, TG: hypertriglyceridemia, HDL-C: high-density lipoprotein cholesterol, LDL-C: low-density lipoprotein cholesterol, LV: left ventricular, LVEF: left ventricular ejection fraction, RA: right atrial, RV: right ventricular

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Table 2

- Baseline characteristics of study participants according to the endpoint

Parameters	Cohort A (n=633)	No mortality (n=525)	Mortality (n=108)	P-value	Cohort A (n=464)	No MACE (n=346)	MACE (n=118)	P-value
Age, (mean±SD)	65.68 (11.98)	64.00 (11.77)	73.83 (9.38)	<0.001	63.00 (11.92)	61.66 (11.56)	66.95 (12.16)	<0.001
Female	451 (71.2)	392 (74.7)	59 (54.6)	<0.001	109 (23.5)	76 (22.0)	33 (28.0)	0.229
hypertension, n (%)	343 (54.2)	284 (54.1)	59 (54.6)	1.000	265 (57.1)	193 (55.8)	72 (61.0)	0.376
diabetes, n (%)	139 (22.0)	112 (21.3)	27 (25.0)	0.477	150 (32.3)	109 (31.5)	41 (34.7)	0.592
WBC (×109/L)	10.60 (4.42)	10.22 (4.03)	12.43 (5.63)	<0.001	10.05 (3.66)	9.86 (3.58)	10.60 (3.86)	0.058
Hb (g/L)	132.86 (20.31)	134.25 (19.75)	126.13 (21.69)	<0.001	143.75 (17.19)	145.22 (17.14)	139.42 (16.66)	0.001
PLT (×109/L)	198.29 (67.83)	202.35 (66.94)	178.52 (68.97)	0.001	231.94 (56.13)	229.12 (54.52)	240.18 (60.08)	0.065
Cr (umol/L)	88.16 (51.83)	82.67 (44.02)	114.83 (74.25)	<0.001	74.62 (22.71)	74.06 (24.66)	76.28 (15.64)	0.36
UA, mean (SD)	347.95 (117.89)	343.14 (113.58)	371.29 (135.12)	0.024	337.18 (73.69)	338.49 (71.24)	333.34 (80.66)	0.513
Albumin (g/L)	38.97 (5.20)	39.32 (5.15)	37.23 (5.09)	<0.001	37.93 (3.83)	37.95 (3.81)	37.88 (3.91)	0.856
TC (mmol/L)	4.55 (1.20)	4.56 (1.17)	4.47 (1.33)	0.471	5.64 (1.13)	5.57 (1.17)	5.87 (0.99)	0.011
TG (mmol/L)	1.56 (1.00)	1.60 (1.06)	1.39 (0.58)	0.044	1.10 (0.84)	1.12 (0.90)	1.06 (0.65)	0.534
HDL-C (mmol/L)	1.17 (0.43)	1.17 (0.32)	1.18 (0.77)	0.857	1.20 (0.27)	1.18 (0.27)	1.25 (0.28)	0.027
LDL-C (mmol/L)	2.74 (0.95)	2.76 (0.96)	2.63 (0.94)	0.186	3.04 (0.73)	3.03 (0.73)	3.07 (0.72)	0.545
cTnI (ng/ml)	13.74 (20.74)	13.86 (21.42)	13.14 (17.14)	0.741	16.51 (12.85)	15.85 (13.15)	18.47 (11.75)	0.055
CK-MB (U/L)	85.38 (169.41)	76.95 (140.51)	126.35 (266.08)	0.006	127.29 (89.58)	125.27 (90.12)	133.20 (88.07)	0.407
LV (mm)	52.84 (8.64)	52.48 (8.64)	54.57 (8.44)	0.022	50.45 (6.27)	49.92 (6.15)	51.98 (6.39)	0.002
LA, mean (SD)	40.20 (10.73)	38.66 (10.18)	47.70 (10.20)	<0.001	37.42 (5.66)	37.05 (5.74)	38.51 (5.32)	0.016

Values are presented as mean ± standard deviation, median. CK-Mb: creatin kinase isoenzyme MB, cTnI: cardiac troponin I, Cr: creatinine, Hb: hemoglobin HDL-C: high-density lipoprotein cholesterol, PLT: platelets, UA: uric acid, TC: total cholesterol, TG: hypertriglyceridemia, LDL-C: low-density lipoprotein cholesterol, LV: left ventricular, LA: left atrial, WBC: white blood cell count

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Table 3

- Logistic models for the association between left atrial diameter and all-cause mortality.

Variables	Case/Total	Model 0	Model 1	Model 2	Model 3
Per unit increase		1.08 (1.06, 1.11)	1.09 (1.07, 1.12)	1.10 (1.07, 1.13)	1.10 (1.07, 1.13)
Quartiles
Q1	187/633	Ref	Ref	Ref	Ref
Q2	131/633	2.68 (1.11,6.89)	3.35 (1.34,8.90)	3.38 (1.28,9.53)	2.25 (0.82,6.55)
Q3	151/633	5.32 (2.46,12.83)	5.55 (2.48,13.78)	5.96 (2.51,15.76)	5.09 (2.12,13.56)
Q4	164/633	11.92 (5.78,27.92)	15.46 (7.18,37.53)	19.03 (8.39,49.11)	15.05 (6.58,39.09)
P for trend		<0.001	<0.001	<0.001	<0.001
Per quartile increase		2.22 (1.80,2.79)	2.38 (1.90,3.04)	2.58(2.01,3.38)	2.51(1.94,3.32)

Model 0: left atrial diameter without adjustment. Model 1: adjusted for age and gender. Model 2: adjusted for age, gender, white blood cell count, hemoglobin, troponin and B-type natriuretic peptide levels. Model 3: adjusted for age, gender, white blood cell count, hemoglobin, troponin and B-type natriuretic peptide levels and left ventricular ejection fraction.