Drögemüller A, Seidl K, Schiele R, Schneider S, Gitt A, Gottwik M, von Leitner E R, Poppe C, Rettig-Stürmer G, Senges J
Herzzentrum Ludwigshafen, Kardiologie, Bremserstr. 79 67063 Ludwigshafen, Germany.
Z Kardiol. 2003 Feb;92(2):164-72. doi: 10.1007/s00392-003-0890-y.
of this study was to re-evaluate the association between ventricular arrhythmias and long-term mortality after acute myocardial infarction (AMI) in the thrombolytic era.
MITRA (maximal individual therapy in patients with AMI) is a multicenter registry of 54 hospitals in Germany investigating patients with AMI.
2420 patients received Holter ECG. Positive Holter ECG was defined: > or =10 ventricular premature beats (VPB)/h, or > or =4 couplets/d, or > or =1 non-sustained ventricular tachycardia (nsusVT)/d, or their combination. Mortality rates (median 17 months) were 6.5% without ventricular arrhythmias, with > or =10 VPB/h 15.2% and with the combination of > or =10 VPB/h plus either > or =4 couplets/d or > or =1 nsusVT/d 23.4%. In multivariate analysis, none of the ventricular arrhythmias alone correlated with mortality. There was a significant association between mortality and the combination of > or =10 VPB/h plus > or =4 couplets/d (OR 2.3) or > or =10 VPB/h plus > or =1 nsusVT/d (OR 2.8).
Non-sustained VTs are only associated with poor prognosis if combined with frequent VPBs.
本研究旨在重新评估溶栓时代急性心肌梗死（AMI）后室性心律失常与长期死亡率之间的关联。
MITRA（AMI患者的最大个体化治疗）是德国54家医院对AMI患者进行调查的多中心注册研究。
2420例患者接受了动态心电图检查。动态心电图阳性的定义为：每小时室性早搏（VPB）≥10次，或每日成对室性早搏≥4次，或每日非持续性室性心动过速（nsusVT）≥1次，或上述情况的组合。无室性心律失常患者的死亡率（中位数17个月）为6.5%，每小时VPB≥10次的患者为15.2%，每小时VPB≥10次加每日成对室性早搏≥4次或每日nsusVT≥1次的组合的患者为23.4%。在多变量分析中，单独的室性心律失常均与死亡率无关。死亡率与每小时VPB≥10次加每日成对室性早搏≥4次（比值比2.3）或每小时VPB≥10次加每日nsusVT≥1次（比值比2.8）的组合之间存在显著关联。
非持续性室性心动过速仅在与频繁室性早搏合并时才与预后不良相关。
