在直接经皮冠状动脉介入治疗时代，急性心肌梗死后长期随访期间的心源性猝死与左心室射血分数：HIJAMI-II注册研究结果

Sudden cardiac death and left ventricular ejection fraction during long-term follow-up after acute myocardial infarction in the primary percutaneous coronary intervention era: results from the HIJAMI-II registry.

作者信息

Shiga T, Hagiwara N, Ogawa H, Takagi A, Nagashima M, Yamauchi T, Tsurumi Y, Koyanagi R, Kasanuki H

机构信息

Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.

出版信息

Heart. 2009 Mar;95(3):216-20. doi: 10.1136/hrt.2008.145243. Epub 2008 Aug 26.

OBJECTIVE

To determine the incidence of sudden cardiac death (SCD) according to left ventricular ejection fraction (LVEF) in survivors of myocardial infarction (MI) in the primary percutaneous coronary intervention (PCI) era.

DESIGN

A multicentre observational prospective registered cohort study.

SETTING

18 medical centres in Japan.

PATIENTS

4122 consecutive patients (mean age 66 (SD 12) years, 73.7% male) with acute MI, who were discharged alive.

MAIN OUTCOME MEASURES

The primary end-point was SCD, and a secondary end-point was death from any cause.

RESULTS

Patients were categorised into three groups: LVEF >40% (n = 3416), LVEF < or =40% and >30% (n = 507) and LVEF < or =30% (n = 199). Among all patients, 77.8% received PCI and 3.7% received coronary artery bypass graft surgery. During an average follow-up of 4.1 years, SCD was 1.2% and mortality was 13.1%. Patients with LVEF < or =30% and LVEF < or =40% and >30% were at increased risk for SCD (HR 5.99, 95% CI 2.73 to 13.14, p<0.001, HR 3.37, 95% CI 1.74 to 6.50, p<0.001, respectively), and mortality (HR 3.85, 95% CI 2.96 to 5.00, p<0.001, HR 2.06, 95% CI 1.66 to 2.57, p<0.001, respectively), compared to patients with LVEF >40%. Kaplan-Meier estimates of SCD in patients with LVEF < or =30% were 2.9%, 5.1% and 5.1% at 1, 3 and 5 years, respectively.

CONCLUSION

There is a low incidence of SCD in survivors of MI in the primary PCI era, although LVEF is a predictor of increased risk for SCD.

目的

确定在直接经皮冠状动脉介入治疗（PCI）时代，心肌梗死（MI）幸存者中根据左心室射血分数（LVEF）划分的心脏性猝死（SCD）发生率。

设计

一项多中心观察性前瞻性注册队列研究。

地点

日本的18个医疗中心。

患者

4122例连续的急性心肌梗死患者（平均年龄66（标准差12）岁，73.7%为男性），均存活出院。

主要观察指标

主要终点为SCD，次要终点为任何原因导致的死亡。

结果

患者被分为三组：LVEF>40%（n = 3416），LVEF≤40%且>30%（n = 507），LVEF≤30%（n = 199）。在所有患者中，77.8%接受了PCI，3.7%接受了冠状动脉旁路移植术。在平均4.1年的随访期间，SCD发生率为1.2%，死亡率为13.1%。与LVEF>40%的患者相比，LVEF≤30%和LVEF≤40%且>30%的患者发生SCD的风险增加（风险比分别为5.99，95%置信区间2.73至13.14，p<0.001；风险比3.37，95%置信区间1.74至6.50，p<0.001），死亡风险也增加（风险比分别为3.85，置信区间2.96至5.00，p<0.001；风险比2.06，95%置信区间1.66至2.57，p<0.001）。LVEF≤30%的患者1年、3年和5年的SCD累积发生率分别为2.9%、5.1%和5.1%。

结论

在直接PCI时代，MI幸存者中SCD的发生率较低，尽管LVEF是SCD风险增加的一个预测因素。