Ruiz-Bailén Manuel, Aguayo de Hoyos Eduardo, Ruiz-Navarro Silvia, Issa-Khozouz Ziad, Reina-Toral Antonio, Díaz-Castellanos Miguel Angel, Rodríguez-García Juan-José, Torres-Ruiz Juan Miguel, Cárdenas-Cruz Antonio, Camacho-Víctor Angel
Critical Care and Emergency Department, Hospital de Poniente, El Ejido, Almeria, Spain.
Crit Care Med. 2003 Aug;31(8):2144-51. doi: 10.1097/01.CCM.0000079602.14851.EB.
The aim of this study has been to investigate the factors predisposing to primary or secondary ventricular fibrillation (VF) and the prognosis in Spanish patients with acute myocardial infarction (AMI) during their admission to the intensive care unit or the coronary care unit.
A retrospective, observational study.
The intensive care units and coronary care units of 119 Spanish hospitals.
A retrospective cohort study including all the AMI patients listed in the ARIAM registry (Analysis of Delay in Acute Myocardial Infarction), a Spanish multicenter study. The study period was January 1995 to January 2001.
Factors associated with the onset of VF were studied by univariate analysis. Multivariate analysis was used to evaluate the independent factors for the onset of VF and for mortality. A total of 17,761 patients with AMI were included in the study; 964 (5.4%) developed VF (primary in 735 patients, secondary in 229). In multivariate analysis, the variables that continued to show an association with the development of VF were the Killip and Kimball class, peak creatine kinase, APACHE II score, age, and time from the onset of symptoms to the initiation of thrombolysis. The mortality in the patients with any VF was 31.8% (27.8% in patients with primary VF and 49.1% in patients with secondary VF). The development of VF is an independent predictive factor for mortality in patients with AMI, with a crude odds ratio of 5.12 (95% confidence interval, 4.41-5.95) and an adjusted odds ratio of 2.73 (95% confidence interval, 2.12-3.51).
Despite the considerable improvement in the treatment of AMI in recent years, the onset of either primary or secondary VF is associated with a poor prognosis. It is usually accompanied by extensive necrosis.
本研究旨在调查西班牙急性心肌梗死（AMI）患者在入住重症监护病房或冠心病监护病房期间发生原发性或继发性心室颤动（VF）的易感因素及预后情况。
一项回顾性观察研究。
119家西班牙医院的重症监护病房和冠心病监护病房。
一项回顾性队列研究，纳入了西班牙多中心研究ARIAM注册研究（急性心肌梗死延迟分析）中列出的所有AMI患者。研究时间段为1995年1月至2001年1月。
通过单因素分析研究与VF发作相关的因素。多因素分析用于评估VF发作和死亡的独立因素。本研究共纳入17761例AMI患者；964例（5.4%）发生VF（原发性735例，继发性229例）。多因素分析中，与VF发生仍相关的变量有Killip和Kimball分级、肌酸激酶峰值、急性生理与慢性健康状况评分系统II（APACHE II）评分、年龄以及从症状发作到开始溶栓的时间。任何VF患者的死亡率为31.8%（原发性VF患者为27.8%，继发性VF患者为49.1%）。VF的发生是AMI患者死亡的独立预测因素，粗比值比为5.12（95%置信区间，4.41 - 5.95），校正比值比为2.
