Fisher John D, Buxton Alfred E, Lee Kerry L, Packer Douglas L, Echt Debra S, Denes Pablo, Lehmann Michael H, DiMarco John P, Roy Denis, Hafley Gail E
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Am J Cardiol. 2007 Jul 1;100(1):76-83. doi: 10.1016/j.amjcard.2007.02.055. Epub 2007 May 11.
Patients with coronary artery disease, depressed left ventricular ejection fraction, and nonsustained ventricular tachycardia (VT) have a high mortality rate due to arrhythmic (arrhythmic death/cardiac arrest) and other cardiac causes. The Multicenter UnSustained Tachycardia Trial (MUSTT) investigated whether electrophysiologic study (EPS) was helpful in choosing drug or defibrillator therapy in patients induced into sustained VT. The events committee attempted to categorize follow-up events in patients in MUSTT and to present a detailed breakdown of events. A derivative of the Hinkle-Thaler classification was used, incorporating lessons from other multicenter studies. The committee was blinded to results of EPS and implantable cardioverter-defibrillator (ICD) or other antiarrhythmic therapy status of patients. The primary end point was cardiac arrest or death from arrhythmia. Secondary end points were death from all causes, cardiac causes, and spontaneous sustained VT. Classifications were death and cardiac arrest. Each was similarly divided as arrhythmic with 14 subcategories, e.g., unwitnessed or related to EPS and nonarrhythmic with 10 subcategories, e.g., ischemia. Terminal VF in progressive heart failure was considered nonarrhythmic. Events were reviewed by 2 members. Disagreements were resolved by the 2 members or, if needed, by the full committee. Of the 2,202 patients in MUSTT, there were 902 deaths. Sustained VT requiring cardioversion occurred in 182 patients. An additional 94 patients had resuscitated cardiac arrests. Events occurred in 1,027 patients, and all were reviewed. The 3 leading events were deaths that were classed as sudden/unwitnessed (23% of 902), due to progressive heart failure (22%), or due to noncardiovascular causes (18%). Arrhythmic deaths or cardiac arrests were highest in inducible patients randomized to no antiarrhythmic therapy; next were inducible patients receiving an ICD; and lowest were in patients who were noninducible. In conclusion, the classification system provided a detailed breakdown of events in consistent categories, showing utility for event analysis and interpretation and development of therapeutic strategies. The classifications assigned by the committee were used in all MUSTT outcomes reports, thus affecting all reported outcomes and overall interpretations of the MUSTT.
患有冠状动脉疾病、左心室射血分数降低和非持续性室性心动过速（VT）的患者，由于心律失常（心律失常性死亡/心脏骤停）和其他心脏原因，死亡率很高。多中心非持续性心动过速试验（MUSTT）研究了电生理检查（EPS）在选择诱导为持续性室性心动过速的患者的药物或除颤器治疗方面是否有帮助。事件委员会试图对MUSTT患者的随访事件进行分类，并详细列出事件的分类情况。使用了Hinkle-Thaler分类法的衍生分类法，并纳入了其他多中心研究的经验教训。委员会对患者的EPS结果以及植入式心脏复律除颤器（ICD）或其他抗心律失常治疗状态不知情。主要终点是心脏骤停或心律失常死亡。次要终点是各种原因导致的死亡、心脏原因导致的死亡以及自发持续性室性心动过速。分类为死亡和心脏骤停。每一类又类似地分为14个亚类的心律失常性事件，例如未目击的或与EPS相关的，以及10个亚类的非心律失常性事件，例如缺血性的。进行性心力衰竭中的终末期室颤被视为非心律失常性事件。事件由两名成员进行审查。分歧由这两名成员解决，如有必要，则由全体委员会解决。在MUSTT的2202名患者中，有902人死亡。182名患者发生了需要心脏复律的持续性室性心动过速。另外94名患者发生了复苏成功的心脏骤停。1027名患者发生了事件，所有事件均经过审查。三大主要事件是被归类为突然/未目击的死亡（902例中的23%）、由于进行性心力衰竭导致的死亡（22%）或由于非心血管原因导致的死亡（18%）。在随机接受无抗心律失常治疗的可诱导患者中，心律失常性死亡或心脏骤停发生率最高；其次是接受ICD治疗的可诱导患者；最低的是不可诱导患者。总之，该分类系统对一致类别的事件进行了详细分类，显示出在事件分析、解释以及治疗策略制定方面的实用性。委员会指定的分类用于所有MUSTT结果报告中，从而影响了所有报告的结果以及对MUSTT的总体解释。
