Coviello Ilaria, Pinnacchio Gaetano, Laurito Marianna, Stazi Alessandra, Battipaglia Irma, Barone Lucy, Mollo Roberto, Russo Giulio, Villano Angelo, Sestito Alfonso, Lanza Gaetano Antonio, Crea Filippo
Cardiology Institute, Catholic University of the Sacred Heart, Rome, Italy.
Cardiology. 2013;124(1):63-70. doi: 10.1159/000345779. Epub 2013 Jan 16.
The aim of our study was to assess the prognostic value of heart rate variability (HRV) in ST-segment elevation acute myocardial infarction (STEMI) patients treated by percutaneous transluminal coronary angioplasty (PTCA) and optimal medical therapy.
We enrolled 182 consecutive patients with a first STEMI (59.1 ± 11 years; 82.4% men) treated by primary PTCA. HRV was assessed on 24-hour Holter ECG recordings before discharge and 1 and 6 months after discharge. The primary end point was the occurrence of major clinical events (MCE), defined as death or new acute myocardial infarction (AMI).
At a follow-up of 42 ± 23 months, MCE occurred in 14 patients (7.6%; 3 deaths and 11 re-AMIs). HRV parameters before discharge were significantly lower in patients with MCE, with standard deviation of all RR intervals (SDNN) and very low frequency and low frequency (LF) amplitude being the most predictive variables. HRV assessed at follow-up instead did not significantly predict MCE. At multivariate analysis, only SDNN (HR 0.97; p = 0.02) and LF (HR 0.90; p = 0.04) remained significantly associated with MCE. Lower tertile SDNN and LF values were associated with a multivariate HR of 3.91 (p = 0.015) and of 2.92 (p = 0.048), respectively. Similar results were observed considering re-AMI only as the end point.
In STEMI patients treated by PTCA, HRV assessed before discharge was an independent predictor of MCE and re-AMI.
我们研究的目的是评估心率变异性（HRV）对接受经皮腔内冠状动脉成形术（PTCA）和最佳药物治疗的ST段抬高型急性心肌梗死（STEMI）患者的预后价值。
我们纳入了182例接受直接PTCA治疗的首次STEMI连续患者（年龄59.1±11岁；男性占82.4%）。在出院前、出院后1个月和6个月时通过24小时动态心电图记录评估HRV。主要终点是主要临床事件（MCE）的发生，定义为死亡或新发急性心肌梗死（AMI）。
在42±23个月的随访中，14例患者发生了MCE（7.6%；3例死亡和11例再发AMI）。发生MCE的患者出院前的HRV参数显著较低，所有RR间期的标准差（SDNN）以及极低频和低频（LF）振幅是最具预测性的变量。而随访时评估的HRV并不能显著预测MCE。在多变量分析中，只有SDNN（风险比0.97；p=0.02）和LF（风险比0.90；p=0.04）仍与MCE显著相关。较低三分位数的SDNN和LF值分别与多变量风险比3.91（p=0.015）和2.92（p=0.048）相关。仅将再发AMI作为终点时观察到类似结果。
在接受PTCA治疗的STEMI患者中，出院前评估的HRV是MCE和再发AMI的独立预测指标。
