直接经皮冠状动脉介入治疗急性 ST 段抬高型心肌梗死后早期再灌注时间对诱发性室性心动过速及晚期自发性室性心律失常的影响。
Effect of reperfusion time on inducible ventricular tachycardia early and spontaneous ventricular arrhythmias late after ST elevation myocardial infarction treated with primary percutaneous coronary intervention.
机构信息
Department of Cardiology, Westmead Hospital, New South Wales, Australia.
出版信息
Heart Rhythm. 2011 Apr;8(4):493-9. doi: 10.1016/j.hrthm.2010.11.046. Epub 2010 Nov 30.
BACKGROUND
Prompt thrombolytic reperfusion reduces postinfarct ventricular electrical instability after ST elevation myocardial infarction (STEMI).
OBJECTIVE
The purpose of this study was to examine the relationship between reperfusion time and inducible ventricular tachycardia (VT) early and spontaneous ventricular arrhythmias (VAs) late after primary percutaneous coronary intervention (PCI) for STEMI.
METHODS
Consecutive patients were recruited if they (1) had no prior coronary disease, (2) had been reperfused with primary PCI, (3) had postinfarct ejection fraction ≤40%, and (4) had undergone cardiac electrophysiologic study (n = 128). Three groups were compared according to reperfusion time: early (≤3 hours, n = 26), intermediate (>3-5 hours, n = 45), or delayed reperfusion (>5 hours, n = 57). Spontaneous VA was a composite endpoint of sudden death or defibrillator-treated VA.
RESULTS
Mean ejection fraction (33% ± 5%, 31% ± 6%, and 31% ± 7%, P = .41) and peak creatinine kinase (P = .37) were similar between groups. VT was inducible in 11.5%, 17.8%, and 36.8% of patients in the early, intermediate, and delayed reperfusion groups, respectively (P = .003). At 2 years, the incidence of spontaneous VA was 0%, 8.9%, and 14% in the early, intermediate, and delayed reperfusion groups, respectively (P = .025). By multivariable analysis, delayed reperfusion conferred a sixfold increase in the odds of inducible VT (P = .01). Although inducible VT was the strongest predictor of spontaneous VA (hazard ratio 14.31, P = .001), delayed reperfusion conferred a threefold increase in risk when inducible VT was excluded from the multivariable model (P = .035).
CONCLUSION
Reperfusion time is a critical determinant of postinfarct ventricular electrical instability early and late after STEMI treated with primary PCI.
背景
即刻溶栓再灌注治疗可降低 ST 段抬高型心肌梗死（STEMI）后梗死区心室电不稳定性。
目的
本研究旨在探讨直接经皮冠状动脉介入治疗（PCI）后再灌注时间与早期诱发性室性心动过速（VT）和晚期自发性室性心律失常（VA）的关系。
方法
入选标准为：（1）无既往冠状动脉疾病史；（2）行直接 PCI 再灌注治疗；（3）梗死区射血分数≤40%；（4）行心脏电生理检查（n=128）。根据再灌注时间将患者分为三组：早期（≤3 小时，n=26）、中期（>3-5 小时，n=45）和晚期（>5 小时，n=57）。自发性 VA 是猝死或除颤器治疗 VA 的复合终点。
结果
三组间平均射血分数（33%±5%、31%±6%和 31%±7%，P=0.41）和峰值肌酸激酶（P=0.37）无显著差异。早期、中期和晚期再灌注组 VT 诱发性分别为 11.5%、17.8%和 36.8%（P=0.003）。2 年随访时，自发性 VA 的发生率分别为 0%、8.9%和 14%（P=0.025）。多变量分析显示，晚期再灌注使 VT 诱发性的风险增加 6 倍（P=0.01）。尽管 VT 诱发性是自发性 VA 的最强预测因子（危险比 14.31，P=0.001），但当 VT 诱发性从多变量模型中排除时，晚期再灌注使风险增加 3 倍（P=0.035）。
结论
直接 PCI 治疗 STEMI 后再灌注时间是早期和晚期梗死区心室电不稳定的重要决定因素。
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