From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
Circ Arrhythm Electrophysiol. 2014 Aug;7(4):626-32. doi: 10.1161/CIRCEP.113.000939. Epub 2014 May 26.
We recently showed that the presence of early repolarization (ER) increases the risk of ventricular fibrillation occurrences in the early phase of acute myocardial infarction (AMI). This study aimed to clarify whether an association exists between ER and occurrences of ventricular tachyarrhythmias or sudden death in the chronic phase of AMI.
This study retrospectively enrolled 1131 patients (67±12 years; 862 men) with AMIs surviving 14 days post-AMI. The primary end point was the occurrence of sustained ventricular tachyarrhythmias or sudden death >14 days after the AMI onset. We evaluated the presence of ER from the predischarge ECG (mean 10±3 days post-AMI). ER was defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in inferior or lateral leads. After a median follow-up of 26.2 months, 26 patients had an episode of ventricular tachyarrhythmias or sudden death. A multivariable Cox regression analysis revealed the presence of ER (hazard ratio, 5.37; 95% confidence interval, 2.27-12.69; P<0.001), Killip class on admission of >I (hazard ratio, 2.75; 95% confidence interval, 1.24-6.07; P=0.013), and a left ventricular ejection fraction of <35% (hazard ratio, 11.83; 95% confidence interval, 5.16-27.13; P<0.001) were significantly associated with event occurrences. As features of the ER pattern, ER in the inferior leads, high-amplitude ER, a notched morphology, and ER without ST-segment elevation were associated with an increased risk of event occurrences.
ER observed at a mean of 10 days post-AMI may be a marker for a subsequent risk of ventricular tachyarrhythmias or sudden death.
我们最近发现，早期复极（ER）的存在增加了急性心肌梗死（AMI）早期发生心室颤动的风险。本研究旨在阐明 ER 与 AMI 慢性期发生室性心动过速或心源性猝死之间是否存在关联。
本研究回顾性纳入了 1131 例 AMI 存活患者（67±12 岁；862 例男性），这些患者在 AMI 发生后 14 天内存活。主要终点是 AMI 发病后>14 天发生持续性室性心动过速或心源性猝死。我们从出院前心电图（平均 AMI 后 10±3 天）评估 ER 的存在。ER 定义为下壁或侧壁导联 QRS 终末部分抬高>0.1 mV。在中位随访 26.2 个月后，26 例患者发生室性心动过速或心源性猝死。多变量 Cox 回归分析显示 ER 存在（风险比，5.37；95%置信区间，2.27-12.69；P<0.001）、入院时 Killip 分级>I（风险比，2.75；95%置信区间，1.24-6.07；P=0.013）和左心室射血分数<35%（风险比，11.83；95%置信区间，5.16-27.13；P<0.001）与事件发生显著相关。作为 ER 模式的特征，下壁导联的 ER、高振幅 ER、切迹形态和无 ST 段抬高的 ER 与事件发生风险增加相关。
AMI 发生后 10 天左右观察到的 ER 可能是随后发生室性心动过速或心源性猝死的风险标志物。
