Departement of Cardiology, University of Basel Hospital, Switzerland;
Swiss Med Wkly. 2013 Sep 6;143:w13869. doi: 10.4414/smw.2013.13869. eCollection 2013.
Preventive implantation of an implantable cardioverter defibrillator (ICD) early after myocardial infarction failed to demonstrate a survival benefit in patients with depressed left ventricular ejection fraction (LVEF). This may be explained by early recovery of the LVEF after percutaneous coronary intervention (PCI). We sought to determine the incidence of a sustained LVEF ≤35% in patients with severely depressed LVEF early after a revascularised acute ST-segment elevation myocardial infarction (STEMI).
LVEF was assessed in patients with an acute STEMI treated with PCI in two Swiss high-volume centres within 10 days (in-hospital LVEF) after the STEMI. Those with an in-hospital LVEF ≤35% were scheduled for follow-up LVEF measurement within 6-8 weeks.
A total of 330 patients were included (79% male, mean age 63 ± 12 years). In-hospital LVEF measured 3 ± 3 days after STEMI was ≤35% in 32/330 patients (10%, 95% confidence interval (CI) 13%-67%). LVEF was available in 31/32 (97%) patients at follow-up 53 ± 19 days after STEMI and improved to >35% in 19 patients (61%, 95% CI 42%-78%). The incidence of a LVEF ≤35% at follow-up was 39% (12/31, 95% CI 22%-56%).
Our data demonstrate that the incidence of severely impaired LV function 53 ± 19 days after a STEMI treated with PCI is low. A severely depressed LVEF early after STEMI was present in 10% of all patients. Only 39% of these patients had a persistently impaired LVEF during follow-up. These findings support an expectant strategy before considering primary preventive ICD implantation after STEMI.
在心肌梗死后早期预防性植入植入式心脏复律除颤器（ICD）未能显示出对左心室射血分数（LVEF）降低的患者的生存获益。这可能是由于经皮冠状动脉介入治疗（PCI）后 LVEF 早期恢复所致。我们试图确定在接受经皮冠状动脉介入治疗（PCI）的急性 ST 段抬高型心肌梗死（STEMI）后早期 LVEF 严重降低的患者中，LVEF 持续≤35%的发生率。
在瑞士两个高容量中心，对接受 PCI 治疗的急性 STEMI 患者在 STEMI 后 10 天内（住院期间 LVEF）评估 LVEF。那些住院期间 LVEF≤35%的患者计划在 6-8 周内进行随访 LVEF 测量。
共纳入 330 例患者（79%为男性，平均年龄 63±12 岁）。STEMI 后 3±3 天测量的住院期间 LVEF≤35%的患者有 32/330 例（10%，95%置信区间（CI）为 13%-67%）。STEMI 后 53±19 天，有 31/32（97%）例患者获得 LVEF 随访数据，其中 19 例（61%，95%CI 为 42%-78%）改善至>35%。随访时 LVEF≤35%的发生率为 39%（12/31，95%CI 为 22%-56%）。
我们的数据表明，经 PCI 治疗的 STEMI 后 53±19 天严重左心功能障碍的发生率较低。所有患者中有 10%在 STEMI 后早期出现严重 LVEF 降低。这些患者中只有 39%在随访期间持续存在 LVEF 受损。这些发现支持在考虑对 STEMI 后进行原发性预防 ICD 植入之前采取期待策略。
