Liu Yen-Bin, Wu Chau-Chung, Lee Chii-Ming, Chen Wen-Jone, Wang Tzung-Dau, Chen Peng-Sheng, Lee Yuan-Teh
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University School of Medicine, Taipei, Taiwan, R.O.C.
J Formos Med Assoc. 2006 Jan;105(1):17-24. doi: 10.1016/S0929-6646(09)60104-2.
Ventricular tachyarrhythmia developing in the acute stage of myocardial infarction (MI) is an important cause of sudden cardiac death. The aim of this study was to determine whether dyslipidemia is associated with the occurrence of ventricular tachycardia/fibrillation (VT/VF) during the acute stage of ST-segment elevation MI (STEMI).
A total of 58 patients experiencing VT/VF within 24 hours after the onset of MI were selected as the study group. A group of 58 patients with MI but without VT/VF was selected as the control group matched for sex (overall, 104 males), age (overall, 58 +/- 10 years), and the use of thrombolytic therapy (n = 82). The lipid profiles including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride were measured during the first week and at the third month after the index MI. Other coronary risk factors, and clinical, hemodynamic and angiographic characteristics were also included in the assessment.
During the acute stage, patients with VT/VF had higher levels of LDL-C and lower blood pressure on initial arrival at our hospital. At the 3-month follow-up, those patients with VT/VF showed higher levels of TC, LDL-C and triglyceride. Multivariate analysis revealed that LDL-C (p < 0.001) at the 3-month follow-up, mean blood pressure on arrival (p < 0.01), and the difference in triglyceride levels between the first week and the third month (p < 0.05) were independent predictors for the occurrence of VT/VF in the acute stage of MI.
This study suggests that dyslipidemia imposes a higher risk of developing tachyarrhythmia in the acute phase of STEMI.
心肌梗死(MI)急性期发生的室性快速性心律失常是心源性猝死的重要原因。本研究的目的是确定血脂异常是否与ST段抬高型心肌梗死(STEMI)急性期室性心动过速/心室颤动(VT/VF)的发生有关。
共选取58例MI发病后24小时内发生VT/VF的患者作为研究组。选取58例MI但无VT/VF的患者作为对照组,两组在性别(共104例男性)、年龄(共58±10岁)和溶栓治疗使用情况(n = 82)方面进行匹配。在首次MI后的第一周和第三个月测量血脂谱,包括总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和甘油三酯。评估还包括其他冠状动脉危险因素以及临床、血流动力学和血管造影特征。
在急性期,发生VT/VF的患者入院时LDL-C水平较高,血压较低。在3个月随访时,发生VT/VF的患者TC、LDL-C和甘油三酯水平较高。多变量分析显示,3个月随访时的LDL-C(p < 0.001)、入院时的平均血压(p < 0.01)以及第一周和第三个月之间甘油三酯水平的差异(p < 0.05)是MI急性期VT/VF发生的独立预测因素。
本研究表明,血脂异常在STEMI急性期发生快速性心律失常的风险较高。