Ohno Jun, Watanabe Eiichi, Toyama Junji, Kawamura Takashi, Ohno Miyoshi, Kodama Itsuo
Department of Cardiology, Higashi Municipal Hospital of Nagoya, Nagoya, Japan.
Int J Cardiol. 2004 Feb;93(2-3):263-8. doi: 10.1016/S0167-5273(03)00215-8.
Recent clinical trials suggest that the mortality in high-risk patients with ischemic heart disease can be significantly reduced with the use of implantable cardioverter-defibrillator (ICD). Given the high cost and invasiveness of the procedure, it is important to apply it to the patients after myocardial infarction (MI) highly susceptible to sudden arrhythmic death.
The purpose of this study was to assess clinical predictors of mortality in post-MI patients in Japan.
In 495 consecutive MI survivors, 350 (71%) received acute-reperfusion therapy, whereas 145 (29%) did not. Nonsustained ventricular tachycardia (NSVT) was present in 136 patients (28%) in 24-h ambulatory ECGs at 7+/-6 in-hospital days. Left ventricular dysfunction (LVEF< or =35%) was present in 20/347 patients (5.7%) at 13+/-8 days. Forty-eight patients (9.7%) died during the follow-up period (48+/-13 months); 23 from cardiac and 25 from noncardiac causes. Kaplan-Meier survival analyses showed that mortality rates were higher among patients who were > or =70 years old (log-rank test, P<0.0001); had heart failure at admission (Killip scale> or =2, P=0.001); did not receive acute-reperfusion (P=0.004); and had left ventricular dysfunction with LVEF< or =35% (P=0.02). The presence of NSVT was a significant predictor of death (P=0.036) only in the patients who did not receive acute-reperfusion. Multivariate Cox regression analysis revealed that an independent predictor of total mortality was an age> or =70 (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P<0.00001).
High-risk patients after acute MI can be identified on the basis of age, ventricular dysfunction, heart failure and acute-reperfusion therapy. The presence of NSVT before discharge has a prognostic value only in the patients without acute-reperfusion.
近期临床试验表明，使用植入式心脏复律除颤器（ICD）可显著降低缺血性心脏病高危患者的死亡率。鉴于该手术成本高昂且具有侵入性，将其应用于心肌梗死（MI）后极易发生心律失常性猝死的患者非常重要。
本研究旨在评估日本心肌梗死后患者死亡率的临床预测因素。
在495例连续的心肌梗死幸存者中，350例（71%）接受了急性再灌注治疗，而145例（29%）未接受。在住院7±6天时的24小时动态心电图检查中，136例患者（28%）出现非持续性室性心动过速（NSVT）。在13±8天时，20/347例患者（5.7%）出现左心室功能障碍（左心室射血分数[LVEF]≤35%）。48例患者（9.7%）在随访期间死亡（48±13个月）；23例死于心脏原因，25例死于非心脏原因。Kaplan-Meier生存分析显示，年龄≥70岁的患者死亡率更高（对数秩检验，P<0.0001）；入院时患有心力衰竭（Killip分级≥2级，P=0.001）；未接受急性再灌注治疗（P=0.004）；以及存在左心室功能障碍且LVEF≤35%（P=0.02）。仅在未接受急性再灌注治疗的患者中，NSVT的存在是死亡的显著预测因素（P=0.036）。多因素Cox回归分析显示，全因死亡率的独立预测因素是年龄≥70岁（比值比，1.06；95%置信区间，1.01-1.11；P<0.00001）。
可根据年龄、心室功能障碍、心力衰竭和急性再灌注治疗来识别急性心肌梗死后的高危患者。出院前NSVT的存在仅在未接受急性再灌注治疗的患者中具有预后价值。
