Department of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland.
Swiss Med Wkly. 2012 Jun 8;142:w13604. doi: 10.4414/smw.2012.13604. eCollection 2012.
Life-threatening arrhythmias may complicate the hospital course of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). The optimal duration of electrocardiographic monitoring in such patients is not well established. We aimed to determine the incidence and the time of occurrence of life-threatening arrhythmias in STEMI patients undergoing PPCI.
Data of 382 consecutive patients with STEMI undergoing PPCI were analysed regarding the occurrence of ventricular fibrillation (VF), sustained ventricular tachycardia (sVT) or bradycardia necessitating temporary or permanent pacing.
Of these patients, 55% had inferior STEMI, 41% anterior and 4% lateral STEMI. The infarct-related arteries were the right in 41%, the left anterior descending in 41%, the left circumflex in 16%, the left main stem in 1% and a vein graft in <1%. During hospitalisation, 27 (7.0%) patients developed 29 life-threatening arrhythmias (incidence 7.6%): 19 episodes occurred during PPCI (VF n = 11, bradycardia n = 8), 9 episodes during the first 24 hours after PPCI (VF n = 7, sVT n = 2), and 1 sVT episode in a hypokalemic patient on the 4th post-procedural day. A total of 17 patients (4.5%) died within the first 30 days, and 3 of these died during the PPCI procedure.
Life-threatening arrhythmias occur in a considerable proportion of STEMI patients undergoing PPCI during hospitalisation. Most of these arrhythmias occur during the PPCI procedure. Post-procedural life-threatening arrhythmias are virtually limited to the first 24 hours after PPCI. Thus, routine electrocardiographic monitoring beyond the first 24 hours after PPCI might not be required in most patients with uncomplicated STEMI.
ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PPCI）时可能出现危及生命的心律失常，从而使住院过程复杂化。目前尚未明确此类患者行心电图监测的最佳时长。本研究旨在明确行 PPCI 的 STEMI 患者发生危及生命的心律失常的发生率和时间。
回顾性分析 382 例行 PPCI 的 STEMI 患者的数据，分析其发生室颤（VF）、持续性室性心动过速（sVT）或需要临时或永久性起搏的心动过缓的情况。
这些患者中，55%为下壁 STEMI，41%为前壁 STEMI，4%为侧壁 STEMI。梗死相关动脉为右冠状动脉 41%，左前降支 41%，左回旋支 16%，左主干 1%，静脉桥 1%。住院期间，27 例（7.0%）患者发生 29 次危及生命的心律失常（发生率为 7.6%）：19 次发生于 PPCI 期间（VF 11 次，心动过缓 8 次），9 次发生于 PPCI 后 24 小时内（VF 7 次，sVT 2 次），1 次 sVT 发生于术后第 4 天低钾血症患者。30 天内共有 17 例（4.5%）患者死亡，其中 3 例死亡于 PPCI 过程中。
行 PPCI 的 STEMI 患者在住院期间会发生相当比例的危及生命的心律失常。这些心律失常大多发生于 PPCI 过程中。术后危及生命的心律失常几乎仅限于 PPCI 后 24 小时内。因此，对于大多数无并发症的 STEMI 患者，在 PPCI 后 24 小时后常规进行心电图监测可能并非必需。
