Avezum Alvaro, Piegas Leopoldo S, Goldberg Robert J, Brieger David, Stiles Martin K, Paolini Richard, Huang Wei, Gore Joel M
Dante Pazzanese Institute of Cardiology, Research Division, São Paulo, São Paulo, Brazil.
Am J Cardiol. 2008 Dec 15;102(12):1577-82. doi: 10.1016/j.amjcard.2008.08.009. Epub 2008 Oct 23.
The incidence, prognosis, and factors associated with ventricular arrhythmia (VA) in acute coronary syndrome are unknown. We sought to examine the magnitude, predictors, and outcomes of in-hospital VA in patients with acute coronary syndrome. The population comprised 52,380 patients enrolled in the Global Registry of Acute Coronary Events from 1999 to 2005. The proportion who developed VA during hospitalization was 6.9% (1.8% with ventricular tachycardia, 5.1% with ventricular fibrillation or cardiac arrest). The incidence of in-hospital VA decreased over time (8.0% in 1999, 7.0% in 2002, 5.8% in 2005, p <0.001). In-hospital case-fatality rates were higher in patients with versus those without VA (52% vs 1.6%). Several demographic and clinical variables were associated with the occurrence of VA including ST deviation, Killip class, age, initial cardiac markers, serum creatinine and heart rate, and history of selected co-morbidities. Six-month postdischarge mortality was higher in survivors of in-hospital VA versus those who did not develop VA during hospitalization (odds ratio 1.57, 95% confidence interval 1.27 to 1.95). In conclusion, development of VA during hospitalization for acute coronary syndrome was associated with higher in-hospital and 6-month mortalities.
急性冠脉综合征中心室心律失常（VA）的发生率、预后及相关因素尚不清楚。我们旨在研究急性冠脉综合征患者院内VA的严重程度、预测因素及转归。研究人群包括1999年至2005年纳入全球急性冠脉事件注册研究的52380例患者。住院期间发生VA的比例为6.9%（室性心动过速占1.8%，心室颤动或心脏骤停占5.1%）。院内VA的发生率随时间下降（1999年为8.0%，2002年为7.0%，2005年为5.8%，p<0.001）。有VA的患者院内病死率高于无VA的患者（52%对1.6%）。一些人口统计学和临床变量与VA的发生有关，包括ST段偏移、Killip分级、年龄、初始心脏标志物、血清肌酐、心率以及某些合并症病史。院内VA幸存者出院后6个月的死亡率高于住院期间未发生VA的患者（比值比1.57，95%置信区间1.27至1.95）。总之，急性冠脉综合征住院期间发生VA与较高的院内死亡率和6个月死亡率相关。
