溶栓时代急性心肌梗死后非持续性室性心动过速的预后价值：与频发室性早搏联合的重要性

Prognostic value of non-sustained ventricular tachycardias after acute myocardial infarction in the thrombolytic era: importance of combination with frequent ventricular premature beats.

作者信息

Drögemüller A, Seidl K, Schiele R, Schneider S, Gitt A, Gottwik M, von Leitner E R, Poppe C, Rettig-Stürmer G, Senges J

机构信息

Herzzentrum Ludwigshafen, Kardiologie, Bremserstr. 79 67063 Ludwigshafen, Germany.

出版信息

Z Kardiol. 2003 Feb;92(2):164-72. doi: 10.1007/s00392-003-0890-y.

DOI:10.1007/s00392-003-0890-y

PMID:12596078

Abstract

PURPOSE

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.

METHODS

MITRA (maximal individual therapy in patients with AMI) is a multicenter registry of 54 hospitals in Germany investigating patients with AMI.

RESULTS

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).

CONCLUSION

Non-sustained VTs are only associated with poor prognosis if combined with frequent VPBs.

摘要

目的

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。

方法

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。

结果

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。