Martínez Martínez J A, Mele E, Suárez L
Division of Cardiology, Hospital José de San Martin, University of Buenos Aires, Argentina.
Int J Cardiol. 1990 Jul;28(1):43-9. doi: 10.1016/0167-5273(90)90007-r.
We performed right atrial pacing in 90 consecutive patients 10 to 30 days (mean 16.8 days) after acute myocardial infarction. Right atrial pacing was normal in 28 patients, depression of the ST segment occurred in 27 patients, systolic blood pressure fell below control values in 20 patients and, in 15 patients, right atrial pacing was non-diagnostic. Follow-up was from 12 to 28 months (mean = 17.3). Global mortality was 11.1%, with none of the patients with normal tests dying, 11% of those with ST depression, 30% of those with induced hypotension (P less than 0.01) and 7.1% of those in whom pacing was non-diagnostic. Patients with high clinical risk at discharge in Peel Class III-IV, showed 41.2% mortality during the period of follow-up. None of those had shown normal responses to pacing, but those dying included 50% of the patients with ST depression and 66.7% of those in whom right atrial pacing induced hypotension. Development of new angina during the period of follow-up was more frequent among the patients with ST depression (33.3%) (P less than 0.001). Thus, our results showed that right atrial pacing was useful in predicting mortality after acute myocardial infarction. In patients at high risk, we observed that a fall of systolic blood pressure was the best predictor of mortality.
我们对90例急性心肌梗死后10至30天（平均16.8天）的连续患者进行了右心房起搏。28例患者右心房起搏正常，27例患者出现ST段压低，20例患者收缩压降至对照值以下，15例患者右心房起搏结果无法诊断。随访时间为12至28个月（平均17.3个月）。总体死亡率为11.1%，检查结果正常的患者无一死亡，ST段压低患者死亡率为11%，诱发低血压患者死亡率为30%（P<0.01），起搏结果无法诊断患者死亡率为7.1%。出院时临床风险较高（皮尔分类III-IV级）的患者，随访期间死亡率为41.2%。这些患者中无一例起搏反应正常，但死亡患者包括50%的ST段压低患者和66.7%的右心房起搏诱发低血压患者。随访期间新发生心绞痛在ST段压低患者中更为常见（33.3%）（P<0.001）。因此，我们的结果表明，右心房起搏有助于预测急性心肌梗死后的死亡率。在高危患者中，我们观察到收缩压下降是死亡率的最佳预测指标。
