Ruiz-Bailén Manuel, Gallego de Guzmán María Dolores Pola, Rucabado-Aguilar Luis, Expósito-Ruiz Manuela, Aguayo de Hoyos Eduardo, Castillo-Rivera Ana María, Quirós-Barrera Rosell, Galindo-Rodríguez Silvia, Torres-Ruiz Juan Miguel, Vázquez-García Rafael, Ramos-Cuadra José Angel, Issa-Khozouz Ziad
Department of Critical Care and Emergency, Intensive Care Unit, Hospital Universitario Médico-Quirúrgico del Complejo Hospitalario de Jaén, Spain.
Med Sci Monit. 2009 Jun;15(6):CR280-9.
The aim of this study was to investigate patients with unstable angina (UA) and the predictive factors of these arrhythmias and to determine whether this complication behaves as an independent variable with regard to mortality, increased length of stay in an ICU/CCU, and the performance of percutaneous coronary intervention (PCI).
MATERIAL/METHODS: The retrospective cohort study included all patients diagnosed with UA and included in the Spanish "ARIAM" database between June 1996 and December 2005. Univariate and multivariate analyses were performed to evaluate the factors associated with these arrhythmias. 17,616 patients were included.
Sustained ventricular tachycardia (SVT) occurred in 0.5%. The factors associated with its development were age, cardiogenic shock, and non-sustained ventricular tachycardia. SVT was associated with mortality (adjusted OR: 9.836, 95%CI: 1.81-53.33). Ventricular fibrillation (VF) occurred in 1%. In the multivariate study the variables that persistently associated independently with the development of VF were gender, Killip class, and high degree atrioventricular block (HDAVB). VF was associated with higher mortality (27.1% vs. 0.9%). Nevertheless, VF was not seen to be a variable independently associated with mortality in UA patients. Only VF was an independent variable in length of stay (adjusted OR: 2.059, 95%CI: 1.175-3.609). Neither SVT nor VF were independent variables associated with PCI.
Patients with UA complicated by SVT or VF represent a special high-risk subgroup with poor prognosis, which could lead to their being stratified towards a poor prognosis subgroup.
本研究旨在调查不稳定型心绞痛（UA）患者及其心律失常的预测因素，并确定该并发症在死亡率、重症监护病房/冠心病监护病房住院时间延长以及经皮冠状动脉介入治疗（PCI）方面是否作为一个独立变量。
材料/方法：回顾性队列研究纳入了1996年6月至2005年12月间所有诊断为UA并纳入西班牙“ARIAM”数据库的患者。进行单因素和多因素分析以评估与这些心律失常相关的因素。共纳入17616例患者。
持续性室性心动过速（SVT）发生率为0.5%。与其发生相关的因素为年龄、心源性休克和非持续性室性心动过速。SVT与死亡率相关（校正比值比：9.836，95%可信区间：1.81 - 53.33）。心室颤动（VF）发生率为1%。在多因素研究中，与VF发生持续独立相关的变量为性别、Killip分级和高度房室传导阻滞（HDAVB）。VF与较高死亡率相关（27.1%对0.9%）。然而，在UA患者中VF并非与死亡率独立相关的变量。仅VF是住院时间的独立变量（校正比值比：2.059，95%可信区间：1.175 - 3.609）。SVT和VF均不是与PCI相关的独立变量。
并发SVT或VF的UA患者代表了一个预后较差的特殊高危亚组，这可能导致他们被归为预后不良亚组。
