[急性心肌梗死患者行急诊经皮冠状动脉介入治疗围手术期电风暴的患病率及危险因素]

[Prevalence and risk factors of peri-procedure electrical storm in acute myocardial infarction patients underwent emergency percutaneous coronary intervention].

作者信息

Zhou Tao, Zhou Sheng-hua, Liu Jie-ni, Shen Xiang-qian, Hu Xin-qun, Fang Zhen-fei, Zhao Yan-shu, Tang Jian-jun, Liu Qi-ming, Li Xu-ping, Liu Zhen-jiang, Lü Xiao-ling

机构信息

Department of Cardiology, Second Xiangya Hospital, Central South University, Changsha 410011, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Apr;38(4):337-41.

PMID:20654080

Abstract

OBJECTIVE

To determine the prevalence and to identify risk factors of peri-procedure electrical storm (ES) in patients with acute myocardial infarction (AMI) underwent emergency percutaneous coronary intervention (PCI).

METHODS

The clinical data of 228 AMI patients underwent emergency PCI were retrospectively analyzed and patients were divided into ES group (n = 39) and non-ES (n = 189) group. ES was referred to spontaneous ventricular tachycardia or ventricular fibrillation occurring twice or more within 24 h and requiring emergency treatment including anti-arrhythmic medicine and/or cardioversion or defibrillation.

RESULTS

ES was diagnosed in 39 out of 228 patients (17.1%) during peri-procedure stage. The incidence of ES in patients with various infarct related arteries (IRA) was as follows: 55.6% with left main artery (LM), 23.7% with right coronary artery (RCA), 12.4% with anterior descending branch (LAD) and 0 with left circumflex artery (LCX). Older age, lager diameter of IRA, higher concentration of CK-MB and cTnT, higher incidence of reperfusion arrhythmia (RA), lower grade of TIMI after PCI and higher mortality were associated with increased risks of ES (The P value was 0.043, 0.012, 0.036, 0.018, 0.001, 0.049, respectively). Gender, systolic pressure, diastolic pressure, random blood glucose level, white blood count and concentration of hs-CRP were similar between ES and non-ES patients. Logistic analysis showed that the diameter of IRA (OR 2.381, 95%CI 1.127-5.028, P = 0.023), TIMI grade of IRA after PCI (OR 4.744, 95% CI 1.773-12.691, P = 0.002) and RA (OR 12.680, 95% CI 4.360-36.879, P = 0.000) were the independent risk factors of per-procedure ES in AMI patients underwent emergency PCI.

CONCLUSIONS

The AMI patients with LM as IRA had the highest incidence of ES during emergency PCI and the diameter of IRA, TIMI grade of IRA after PCI and RA were independent risk factors for the development of ES during peri-PCI stage.

摘要

目的

确定急性心肌梗死（AMI）患者行急诊经皮冠状动脉介入治疗（PCI）围手术期电风暴（ES）的发生率并识别其危险因素。

方法

回顾性分析228例行急诊PCI的AMI患者的临床资料，将患者分为ES组（n = 39）和非ES组（n = 189）。ES是指24小时内发生两次或更多次自发性室性心动过速或室颤，且需要包括抗心律失常药物和/或心脏复律或除颤在内的紧急治疗。

结果

228例患者中有39例（17.1%）在围手术期被诊断为ES。不同梗死相关动脉（IRA）患者的ES发生率如下：左主干（LM）为55.6%，右冠状动脉（RCA）为23.7%，前降支（LAD）为12.4%，左旋支（LCX）为0。年龄较大、IRA直径较大、CK-MB和cTnT浓度较高、再灌注心律失常（RA）发生率较高、PCI术后TIMI分级较低以及死亡率较高与ES风险增加相关（P值分别为0.043, 0.012, 0.036, 0.018, 0.001, 0.049）。ES患者和非ES患者在性别、收缩压、舒张压、随机血糖水平、白细胞计数和hs-CRP浓度方面相似。Logistic分析显示，IRA直径（OR 2.381, 95%CI 1.127 - 5.028, P = 0.023）、PCI术后IRA的TIMI分级（OR 4.744, 95%CI 1.773 - 12.691, P = 0.002）和RA（OR 12.680, 95%CI 4.360 - 36.879, P = 0.000）是行急诊PCI的AMI患者围手术期ES的独立危险因素。