Yang Hyun Suk, Lee Cheol Whan, Hong Myeong-Ki, Lee Jae-Hwan, Nam Gi-Byoung, Choi Kee-Joon, Kim Jae-Joong, Park Seong-Wook, Kim You-Ho, Park Seung-Jung
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Clin Cardiol. 2003 Aug;26(8):373-6. doi: 10.1002/clc.4950260805.
The benefits of residual flow to the infarct zone have been demonstrated in acute myocardial infarction (AMI), but its relation to ventricular tachyarrhythmias remains uncertain.
This study was undertaken to test the hypothesis that residual flow is an important determinant of lethal ventricular tachyarrhythmias (sustained ventricular tachycardia or ventricular fibrillation) during the acute phase of AMI.
We investigated the determinants of lethal ventricular tachyarrhythmias within 24 h after the onset of symptoms in 310 consecutive patients (256 men; age 57.4 +/- 11.5 years) with AMI undergoing primary angioplasty. Patients were divided into two groups: those with (Group 1, n = 40) and those without (Group 2, n = 270) lethal ventricular tachyarrhythmias. Residual flow was defined as the presence of anterograde flow (> or = Thrombolysis in Myocardial Infarction [TIMI] 2 flow) or good angiographic collaterals (> or = grade 2) on a preintervention angiogram.
Univariate determinants of lethal ventricular tachyarrhythmias were cardiogenic shock, systolic blood pressure, peak level of creatine kinase, culprit artery, spontaneous reperfusion, and residual flow. In multivariate analysis, however, cardiogenic shock (odds ratio [OR] = 4.79, 95% confidence interval [CI] 1.63-14.11, p = 0.004), residual flow (OR = 0.34, 95% CI 0.14-0.81, p = 0.015), and the right coronary artery as the culprit artery (OR = 2.09,95% CI 1.03-4.22, p = 0.040) were independent determinants of these arrhythmias. In-hospital death occurred in 10 patients and was more common in Group 1 than in Group 2 (12.5% vs. 1.9%, respectively, p < 0.001).
The absence of residual flow was associated with greater risk of lethal ventricular tachyarrhythmias during the acute phase of AMI, suggesting a protective role of residual flow against these arrhythmias in AMI.
在急性心肌梗死（AMI）中，梗死区域存在残余血流的益处已得到证实，但其与室性快速心律失常的关系仍不明确。
本研究旨在验证以下假设，即残余血流是AMI急性期致死性室性快速心律失常（持续性室性心动过速或心室颤动）的重要决定因素。
我们调查了310例接受直接血管成形术的AMI连续患者（256例男性；年龄57.4±11.5岁）症状发作后24小时内致死性室性快速心律失常的决定因素。患者分为两组：发生致死性室性快速心律失常的患者（第1组，n = 40）和未发生的患者（第2组，n = 270）。残余血流定义为干预前血管造影显示存在顺行血流（≥心肌梗死溶栓治疗[TIMI]2级血流）或良好的血管造影侧支循环（≥2级）。
致死性室性快速心律失常的单因素决定因素有心源性休克、收缩压、肌酸激酶峰值、罪犯血管、自发再灌注和残余血流。然而，在多因素分析中，心源性休克（比值比[OR]=4.79，95%置信区间[CI]1.63 - 14.11，p = 0.004）、残余血流（OR = 0.34，95%CI 0.14 - 0.81，p = 0.015）以及罪犯血管为右冠状动脉（OR = 2.09，95%CI 1.03 - 4.22，p = 0.040）是这些心律失常的独立决定因素。10例患者发生院内死亡，第1组比第2组更常见（分别为12.5%和1.9%，p < 0.001）。
在AMI急性期，残余血流的缺失与致死性室性快速心律失常的风险增加相关，提示残余血流对AMI中的这些心律失常具有保护作用。
