Lorenz Herbert, Jünger Claus, Seidl Karlheinz, Gitt Anselm, Schneider Steffen, Schiele Rudolf, Wienbergen Harm, Winkler Ralph, Gottwik Martin, Delius Wolfram, Senges Jochen, Rauch Bernhard
Institut für Herzinfarktforschung, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen am Rhein, Herzzentrum Ludwigshafen, Germany.
Eur Heart J. 2005 Jun;26(11):1078-85. doi: 10.1093/eurheartj/ehi150. Epub 2005 Feb 23.
The study evaluates the effect of statin therapy on the prognostic impact of non-sustained ventricular tachycardia (NSVT) occurring after acute ST-elevation myocardial infarction (STEMI).
From the German Acute Coronary Syndrome Registry (ACOS), 3137 patients with STEMI and in-hospital Holter monitoring were analysed. Three hundred and forty-six (11.0%) patients had NSVT. When compared with patients with no documented NSVT, patients with NSVT were older, more often had myocardial infarction in their history, diabetes mellitus, and an ejection fraction <40%. Regarding frequency of drug application, medication at discharge did not (beta-blockers, ACE-inhibitors, amiodarone) or only slightly (acetylsalicylic acid, statins, and sotalol) differ between both groups. Multivariable analysis of 1 year mortality, adjusted for age, gender, diabetes, reperfusion therapy, ejection fraction <40%, and beta-blocker therapy showed the following results: In patients without statin treatment and no NSVT, 1 year mortality after STEMI was 9.2%, but increased to 25.0% [odds ratio (OR) 3.02; 95% confidence interval (CI) 1.47-6.20], if NSVT were present. In patients on statin treatment and no NSVT, 1 year mortality was only 3.2%, and in the presence of NSVT 1 year mortality was not significantly increased anymore (5.3%; OR 1.03; 95% CI 0.55-1.92).
After STEMI, only in patients not on statin treatment, the occurrence of NSVT is associated with a significant and marked increase in 1 year mortality.
本研究评估他汀类药物治疗对急性ST段抬高型心肌梗死（STEMI）后发生的非持续性室性心动过速（NSVT）预后影响的作用。
对德国急性冠状动脉综合征注册研究（ACOS）中3137例STEMI且进行院内动态心电图监测的患者进行分析。346例（11.0%）患者发生NSVT。与无NSVT记录的患者相比，发生NSVT的患者年龄更大，既往心肌梗死、糖尿病病史更常见，且射血分数<40%。关于药物应用频率，两组间出院时用药情况（β受体阻滞剂、血管紧张素转换酶抑制剂、胺碘酮）无差异或仅有轻微差异（阿司匹林、他汀类药物和索他洛尔）。对1年死亡率进行多变量分析，校正年龄、性别、糖尿病、再灌注治疗、射血分数<40%和β受体阻滞剂治疗后，结果如下：未接受他汀类药物治疗且无NSVT的患者，STEMI后1年死亡率为9.2%，但如果存在NSVT，死亡率则升至25.0%[比值比（OR）3.02；95%置信区间（CI）1.47 - 6.20]。接受他汀类药物治疗且无NSVT的患者，1年死亡率仅为3.2%，存在NSVT时1年死亡率不再显著升高（5.3%；OR 1.03；95% CI 0.55 - 1.92）。
STEMI后，仅在未接受他汀类药物治疗的患者中，NSVT的发生与1年死亡率显著且明显升高相关。
