Vismara L A, Amsterdam E A, Mason D T
Am J Med. 1975 Jul;59(1):6-12. doi: 10.1016/0002-9343(75)90315-0.
To determine the prognostic significance of ventricular arrhythmias persisting during the hospital ambulatory phase of acute myocardial infarction, 64 patients with acute myocardial infarction underwent continuous 10-hour Holter monitoring an average of 11 days after discharge from the coronary care unit (CCU). Patients were categorized according to the results of ambulatory monitoring: 27 patients had ventricular extrasystoles, which were complicated (multifocal, R on T, paired, more than 5/min), or ventricular tachycardia; 22 had uncomplicated premature ventricular contractions; and 15 exhibited no ventricular arrhythmias. The 64 patients were followed prospectively for an average course of 25.8 months; 12 died suddenly; 8 died of other causes, and 44 survived. In all patients who died suddenly, ventricular ectopy was recorded on Holter monitoring before their discharge from the hospital (complicated premature ventricular contractions, eight patients; uncomplicated premature ventricular contractions, four patients); there were no sudden deaths in the patients without ventricular arrhythmias. Patients who died suddenly and those survived were similar in respect to age (60, 62 years), sex, location of infarction, presence of coronary risk factors, severity of acute myocardial infarction (Q waves, cardiac enzymes), serum cholesterol levels, evidence of cardiomegaly on roentgenograms, presence of ventricular gallop and drug therapy received. The occurrence of acute arrhythmias in the CCU did not separate patients who died suddenly from those who survived; there were no differences in ventricular tachycardia or ventricular fibrillation (3 or 12 patients who died suddenly, 6 of 44 patients who survived) or complicated premature ventricular contractions (4 or 12 patients who died suddenly, 18 of 44 patients who survived). Electrocardiograms obtained late in the hospital course revealed no differences in the extent of Q or T wave changes between these two groups. However, the extent of S-T segment abnormality was greater in patients who died suddenly than in patients who survived (5.6 compared to 1.8 leads/standard tracing, p smaller than 0.02) suggesting that the arrhythmias in the former were related to persistent ischemia or segmental ventricular dyssynergy. Thus, in this relatively small number of patients, ventricular arrhythmias persisting late in the hospital course of patients admitted for acute myocardial infarction are shown to predispose to subsequent sudden death.
为了确定急性心肌梗死患者在出院后门诊阶段持续存在的室性心律失常的预后意义，64例急性心肌梗死患者在从冠心病监护病房（CCU）出院后平均11天接受了连续10小时的动态心电图监测。根据动态监测结果对患者进行分类：27例患者有室性期前收缩，且为复杂性（多灶性、R波落在T波上、成对、每分钟超过5次）或室性心动过速；22例有非复杂性室性早搏；15例未出现室性心律失常。对这64例患者进行了平均25.8个月的前瞻性随访；12例猝死；8例死于其他原因，44例存活。在所有猝死患者中，出院前动态心电图监测均记录到室性异位搏动（复杂性室性早搏8例；非复杂性室性早搏4例）；无室性心律失常的患者未发生猝死。猝死患者和存活患者在年龄（60、62岁）、性别、梗死部位、冠心病危险因素、急性心肌梗死严重程度（Q波、心肌酶）、血清胆固醇水平、X线胸片显示的心脏扩大证据、室性奔马律及接受的药物治疗方面相似。CCU中急性心律失常的发生情况并不能区分猝死患者和存活患者；室性心动过速或心室颤动的发生率在两组间无差异（猝死患者3例或12例，存活患者44例中的6例），复杂性室性早搏的发生率也无差异（猝死患者4例或12例，存活患者44例中的18例）。住院后期获得的心电图显示，两组间Q波或T波改变的程度无差异。然而，猝死患者的ST段异常程度大于存活患者（分别为5.6个导联/标准心电图与1.8个导联/标准心电图，p<0.02），提示前者的心律失常与持续性缺血或节段性心室协同失调有关。因此，在这相对少数的患者中，急性心肌梗死患者住院后期持续存在的室性心律失常被证明易导致随后的猝死。
