State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Cardiology, Hangzhou First People's Hospital and Hangzhou Hospital of Nanjing Medical University, Hangzhou, China.
Heart. 2014 Aug;100(16):1242-9. doi: 10.1136/heartjnl-2013-305144. Epub 2014 Jun 3.
To determine the incidence and predictors of sudden cardiac death (SCD) in the current era of revascularisation of myocardial infarction (MI) survivors with reduced LVEF.
A prospective observational study was conducted in FuWai Hospital from 2004 to 2009. A total of 1018 consecutive patients who had an LVEF ≤35% and New York Heart Association Class II/III heart failure at least 40 days after MI were enrolled if they were not available for implantation of an implantable cardioverter defibrillator. The degree of coronary artery disease and revascularisation were analysed. The primary outcome was SCD and secondary outcome was all-cause death.
During a mean follow-up of 2.8 years, the SCD rate was 5% and all-cause mortality was 7.4%. The annual incidence of SCD was 1.8%. Kaplan-Meier analysis showed that the cumulative rate of SCD was significantly increased in patients with triple-vessel disease (6.7% vs 0.6%), left main coronary disease (10.3% vs 4.1%), EF ≤25% (8.3% vs 3.9%) and non-revascularisation therapy (9.6% vs 2.7%) (all log-rank, p<0.05). After multivariable Cox regression analysis, the risk of SCD was predicted by age (HR 1.05, 95% CI 1.02 to 1.09), EF ≤25% (HR 1.82, 95% CI 1.04 to 3.21) and non-revascularisation (HR 3.97, 95% CI 2.15 to 7.31).
Revascularisation may reduce the risk of SCD in post-MI patients with an LVEF ≤35% on the basis of medical therapy, and the increased risk for SCD may be predicted by age, LVEF ≤25% and non-revascularisation.
确定在目前接受血运重建治疗的射血分数降低的心肌梗死（MI）幸存者中，心源性猝死（SCD）的发生率和预测因素。
一项前瞻性观察性研究于 2004 年至 2009 年在阜外医院进行。共纳入 1018 例连续患者，这些患者在 MI 后至少 40 天 LVEF≤35%和纽约心脏协会心功能 II/III 级心力衰竭，如果不能植入植入式心脏复律除颤器，则可接受该治疗。分析了冠状动脉疾病的严重程度和血运重建情况。主要终点为 SCD，次要终点为全因死亡。
在平均 2.8 年的随访期间，SCD 发生率为 5%，全因死亡率为 7.4%。SCD 的年发生率为 1.8%。Kaplan-Meier 分析显示，三支血管病变（6.7% vs 0.6%）、左主干病变（10.3% vs 4.1%）、EF≤25%（8.3% vs 3.9%）和非血运重建治疗（9.6% vs 2.7%）患者的 SCD 累积发生率显著增加（所有 log-rank，p<0.05）。多变量 Cox 回归分析显示，SCD 的风险由年龄（HR 1.05，95%CI 1.02 至 1.09）、EF≤25%（HR 1.82，95%CI 1.04 至 3.21）和非血运重建（HR 3.97，95%CI 2.15 至 7.31）预测。
在接受基于药物治疗的射血分数≤35%的 MI 后患者中，血运重建可能降低 SCD 的风险，SCD 的风险增加可能由年龄、EF≤25%和非血运重建预测。
