微伏 T 波电交替预测经皮冠状动脉介入治疗急性心肌梗死后患者的心脏事件。

Microvolt T-wave alternans predicts cardiac events after acute myocardial infarction in patients treated with primary percutaneous coronary intervention.

机构信息

I Department of Cardiology, Medical University of Silesia, Katowice, Poland.

出版信息

Adv Med Sci. 2012;57(2):328-33. doi: 10.2478/v10039-012-0033-7.

DOI:10.2478/v10039-012-0033-7

PMID:23183770

Abstract

BACKGROUND

Current risk stratification after acute myocardial infarction (MI) depends on left ventricular ejection fraction. Microvolt T-wave alternans (MTWA) is one of promising markers to predict cardiac events in patients after acute MI treated according to current guidelines.

METHODS

In this single center study, 112 consecutive patients with the first anterior ST-elevation MI undergoing PCI <12 hours from symptom onset, were enrolled prospectively. Demographics, established risk factors, myocardial contrast echocardiography (MCE) perfusion, index event data and MTWA were assessed. Composite cardiac events (CCE) defined as: death, recurrent MI, sustained ventricular tachycardia (sVT) or readmission for acute heart failure (HF) were recorded during follow-up.

RESULTS

MTWA test was negative in 76, positive in 18 and undetermined in 7 patients. MTWA negative patients had significantly higher LVEF at 30 days. At 4 years, 26 patients experienced CCE (10 died, 2 reinfarcted and 14 HF events). In multivariate Cox proportional hazard model maximum CKMB, non-negative MTWA and reduced LVEF made the best model to predict CCE. Four year CCE free survival was 77% and was significantly lower for non-negative MTWA (94% vs 50%, p<0.003).

CONCLUSIONS

Non-negative MTWA with infarct size index and reduced LVEF could predict cardiac events in patients with anterior STEMI treated with primary PCI. MTWA non-negative patients have significantly worse outcome.

摘要

背景

目前急性心肌梗死（MI）后的风险分层依赖于左心室射血分数。微伏级 T 波电交替（MTWA）是一种有前途的标志物，可预测根据现行指南治疗的急性 MI 后患者的心脏事件。

方法

在这项单中心研究中，前瞻性纳入了 112 例连续的首次前壁 ST 段抬高 MI 患者，这些患者在症状发作后 12 小时内行 PCI。评估了人口统计学、已确立的危险因素、心肌对比超声心动图（MCE）灌注、指数事件数据和 MTWA。在随访期间记录了复合心脏事件（CCE）：死亡、再发 MI、持续性室性心动过速（sVT）或因急性心力衰竭（HF）再次入院。

结果

MTWA 试验阴性 76 例，阳性 18 例，不确定 7 例。MTWA 阴性患者在 30 天时左心室射血分数显著更高。在 4 年时，26 例患者发生 CCE（10 例死亡、2 例再梗死和 14 例 HF 事件）。在多变量 Cox 比例风险模型中，最大 CKMB、非阴性 MTWA 和左心室射血分数降低是预测 CCE 的最佳模型。4 年 CCE 无事件生存率为 77%，非阴性 MTWA 显著降低（94%对 50%，p<0.003）。