Yap Yee Guan, Duong Trinh, Bland Martin, Malik Marek, Torp-Pedersen Christian, Køber Lars, Connolly Stuart J, Marchant Bradley, Camm John
Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
Eur Heart J. 2005 Jul;26(14):1385-93. doi: 10.1093/eurheartj/ehi268. Epub 2005 May 24.
An understanding of the temporal trends on the risks of arrhythmic death (AD) vs. non-arrhythmic deaths (NAD) after myocardial infarction (MI) is crucial in deciding the optimal timing for risk stratification and treatment window for prophylactic antiarrhythmic treatment. However, contemporary data on such information is lacking.
Individual patient data were pooled from the placebo arms of EMIAT, CAMIAT, SWORD, TRACE, and DIAMOND-MI who had a recent MI and left ventricular ejection fraction (LVEF) <40% or frequent ventricular premature beats (VPBs). Temporal trends were investigated for all studies from day 45 after acute myocardial infarction (AMI) to account for different recruitment periods between trials, and then from the onset of MI for TRACE and DIAMOND-MI that recruited patients within 2 weeks after MI. In total, 3104 patients (median age 65, range: 23-92; 2471 males) were pooled from all five studies, with a total of 487 deaths at 2-year follow-up; 220 deaths were ADs and 172 were NADs. The risks of both AD and NAD were highest in the first 6 months but the risk of AD was consistently higher than that of NAD throughout the 2-year period [rate of death/100 person-year at risk (AD/NAD): 8.09/6.07 (45 days to 6 months), 4.07/3.35 (>6-12 months), 4.34/3.60 (>12-18 months), 3.76/2.77 (>18-24 months)]. There were significant interactions between the temporal trends of mortalities and gender (P=0.03) and history of hypertension (P=0.04). A similar trend was observed when mortality was measured from time of onset of MI from the combined TRACE and DIAMOND-MI dataset.
Our study provided the first contemporary evidence that in high-risk post-MI patients with LVEF <40% or frequent VPBs, the risk of AD was higher than that of NAD for up to 2 years although in female patients, they became increasingly more likely to die from NAD after 6 months. Therefore, risk stratification of post-MI patient at high risk of AD remains a worthwhile exercise. However, the risks of AD (and NAD) were highest in the first 6 months after AMI and level-off thereafter, suggesting that the optimal window period for risk stratification for implantable cardioverter defibrillator after AMI is in the first 6 months.
了解心肌梗死（MI）后心律失常性死亡（AD）与非心律失常性死亡（NAD）风险的时间趋势，对于确定风险分层的最佳时机以及预防性抗心律失常治疗的治疗窗至关重要。然而，目前缺乏关于此类信息的当代数据。
从EMIAT、CAMIAT、SWORD、TRACE和DIAMOND-MI的安慰剂组中汇总个体患者数据，这些患者近期发生MI且左心室射血分数（LVEF）<40%或频发室性早搏（VPB）。对所有研究从急性心肌梗死（AMI）后45天开始调查时间趋势，以考虑各试验之间不同的招募期，然后对于TRACE和DIAMOND-MI从MI发作开始调查时间趋势，这两项研究在MI后2周内招募患者。总共从所有五项研究中汇总了3104例患者（中位年龄65岁，范围：23 - 92岁；2471例男性），在2年随访时有487例死亡；220例为AD死亡，172例为NAD死亡。AD和NAD的风险在前6个月均最高，但在整个2年期间AD的风险始终高于NAD [每100人年风险的死亡率（AD/NAD）：8.09/6.07（45天至6个月），4.07/3.35（>6 - 12个月），4.34/3.60（>12 - 18个月），3.76/2.77（>18 - 24个月）]。死亡率的时间趋势与性别（P = 0.03）和高血压病史（P = 0.04）之间存在显著交互作用。从TRACE和DIAMOND-MI合并数据集的MI发作时间测量死亡率时观察到类似趋势。
我们的研究提供了首个当代证据，即在LVEF<40%或频发VPB的高危MI后患者中，AD风险在长达2年的时间内高于NAD，尽管在女性患者中，6个月后死于NAD的可能性越来越大。因此，对AD高危的MI后患者进行风险分层仍然是一项有价值的工作。然而，AD（和NAD）的风险在AMI后的前6个月最高，此后趋于平稳，这表明AMI后植入式心脏复律除颤器风险分层的最佳窗口期在前6个月。
