非ST段抬高型心肌梗死患者院内危及生命的室性心律失常和死亡的入院时风险分层。
At-admission risk stratification for in-hospital life-threatening ventricular arrhythmias and death in non-ST elevation myocardial infarction patients.
作者信息
Zorzi Alessandro, Turri Riccardo, Zilio Filippo, Spadotto Veronica, Baritussio Anna, Peruzza Francesco, Gasparetto Nicola, Marra Martina Perazzolo, Cacciavillani Luisa, Marzari Armando, Tarantini Giuseppe, Iliceto Sabino, Corrado Domenico
机构信息
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
出版信息
Eur Heart J Acute Cardiovasc Care. 2014 Dec;3(4):304-12. doi: 10.1177/2048872614528796. Epub 2014 Mar 27.
AIMS
Identification of patients with non-ST elevation acute myocardial infarction (NSTEMI) at higher risk of in-hospital life-threatening ventricular arrhythmias (LT-VA) and death is crucial for determining appropriate levels of care/monitoring during hospitalisation. We assessed predictors of in-hospital LT-VA and all-cause mortality in a consecutive series of NSTEMI patients.
METHODS AND RESULTS
We prospectively studied 1325 consecutive patients (69.7% males, median age 70 (61-79) years) presenting with NSTEMI and undergoing continuous electrocardiographic monitoring. The primary study end-point was the occurrence of spontaneous (unrelated to coronary interventions) in-hospital LT-VA, including sustained ventricular tachycardia and ventricular fibrillation; the secondary end-point was in-hospital mortality from all causes. Of 1325 patients, 21 (1.5%) experienced LT-VA and 62 (4.7%) died from either arrhythmias (n=1) or other causes (n=61). Seven of the 20 patients who survived LT-VA subsequently died of heart failure. Independent predictors of in-hospital LT-VA were the Global Registry of Acute Coronary Events (GRACE) score >140 (odds ratio (OR)=7.5; 95% confidence interval (CI) 1.7-33.3; p=0.008) and left ventricular ejection fraction (LV-EF)<35% (OR=4.1; 95% CI 1.7-10.3; p=0.002). GRACE score >140 (OR=14.6; 95% CI 3.4-62) and LV-EF <35% (OR=4.4; 95% CI 1.9-10) also predicted in-hospital all-cause death. The cumulative probability of in-hospital LT-VA and death was respectively 9.2% and 23% in the 98 (7.4%) patients with GRACE score >140 and LV-EF<35%, while it was respectively 0.2% and 0% among the 627 (47.3%) with GRACE score ≤140 and LV-EF ≥35%.
CONCLUSIONS
Simple risk stratification at admission based on GRACE score and echocardiographic LV-EF allows early identification of NSTEMI patients at higher risk of both in-hospital LT-VA and all-cause mortality.
目的
识别非ST段抬高型急性心肌梗死（NSTEMI）患者中发生院内危及生命的室性心律失常（LT-VA）和死亡风险较高者，对于确定住院期间适当的护理/监测水平至关重要。我们评估了一系列连续的NSTEMI患者中院内LT-VA和全因死亡率的预测因素。
方法和结果
我们前瞻性研究了1325例连续的NSTEMI患者（男性占69.7%，中位年龄70（61 - 79）岁），这些患者均接受持续心电图监测。主要研究终点是自发性（与冠状动脉介入无关）院内LT-VA的发生，包括持续性室性心动过速和心室颤动；次要终点是全因院内死亡率。在1325例患者中，21例（1.5%）发生了LT-VA，62例（4.7%）死于心律失常（n = 1）或其他原因（n = 61）。在LT-VA存活的20例患者中，有7例随后死于心力衰竭。院内LT-VA的独立预测因素是全球急性冠状动脉事件注册（GRACE）评分>140（比值比（OR）=7.5；95%置信区间（CI）1.7 - 33.3；p = 0.008）和左心室射血分数（LV-EF）<35%（OR = 4.1；95%CI 1.7 - 10.3；p = 0.002）。GRACE评分>140（OR = 14.6；95%CI 3.4 - 62）和LV-EF <35%（OR = 4.4；95%CI 1.9 - 10）也预测了院内全因死亡。在GRACE评分>140且LV-EF<35%的98例（7.4%）患者中，院内LT-VA和死亡的累积概率分别为9.2%和23%，而在GRACE评分≤140且LV-EF≥35%的627例（47.3%）患者中，该概率分别为0.2%和0%。
结论
基于GRACE评分和超声心动图LV-EF在入院时进行简单的风险分层，可早期识别出有较高院内LT-VA和全因死亡风险的NSTEMI患者。
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