Demidova Marina M, Carlson Jonas, Erlinge David, Platonov Pyotr G
Department of Cardiology, Lund University, Lund, Sweden; Federal Medical Research Center, St. Petersburg, Russia.
Department of Cardiology, Lund University, Lund, Sweden.
Am J Cardiol. 2015 Feb 15;115(4):417-22. doi: 10.1016/j.amjcard.2014.11.025. Epub 2014 Nov 29.
Ventricular fibrillation (VF) during reperfusion (rVF) in ST-segment elevation myocardial infarction (STEMI) is an infrequent but serious event that complicates coronary interventions. The aim of this study was to analyze clinical predictors of rVF in an unselected population of patients with STEMI treated with percutaneous coronary intervention (PCI). Consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2012 were retrospectively assessed for the presence of rVF. Admission electrocardiograms, stored in a digital format, were analyzed for a maximal ST-segment elevation in a single lead and the sum of ST-segment deviations in all leads. Clinical, electrocardiographic, and angiographic characteristics were tested for associations with rVF using logistic regression analysis. Among 3,724 patients with STEMI admitted from 2007 to 2012, 71 (1.9%) had rVF. In univariate analysis, history of myocardial infarction, aspirin and β-blocker use, VF before PCI, left main coronary artery disease, inferior myocardial infarction localization, symptom-to-balloon time <360 minutes, maximal ST-segment elevation in a single lead >300 μV, and sum of ST-segment deviations in all leads >1,500 μV were associated with increased risk for rVF. In a multivariate analysis, sum of ST-segment deviations in all leads >1500 μV (odds ratio 3.7, 95% confidence interval 1.45 to 9.41, p = 0.006) before PCI remained an independent predictor of rVF. In-hospital mortality was 18.3% in the rVF group and 3.3% in the group without VF (p <0.001), but rVF was not an independent predictor of in-hospital death. In conclusion, the magnitude of ST-segment elevation before PCI for STEMI independently predicts rVF and should be considered in periprocedural arrhythmic risk assessment. Despite higher in-hospital mortality in patients with rVF, rVF itself has no independent prognostic value for prognosis.
ST段抬高型心肌梗死（STEMI）再灌注期间的室颤（rVF）是一种少见但严重的事件，会使冠状动脉介入治疗变得复杂。本研究的目的是分析在接受经皮冠状动脉介入治疗（PCI）的未选择的STEMI患者人群中rVF的临床预测因素。对2007年至2012年因原发性PCI入住三级护理医院的连续性STEMI患者进行回顾性评估，以确定是否存在rVF。对以数字格式存储的入院心电图进行分析，以确定单导联最大ST段抬高以及所有导联ST段偏移总和。使用逻辑回归分析测试临床、心电图和血管造影特征与rVF的相关性。在2007年至2012年入院的3724例STEMI患者中，71例（1.9%）发生了rVF。在单因素分析中，心肌梗死病史、阿司匹林和β受体阻滞剂的使用、PCI前室颤、左主干冠状动脉疾病、下壁心肌梗死定位、症状到球囊时间<360分钟、单导联最大ST段抬高>300μV以及所有导联ST段偏移总和>1500μV与rVF风险增加相关。在多因素分析中，PCI前所有导联ST段偏移总和>1500μV（比值比3.7，95%置信区间1.45至9.41，p = 0.006）仍然是rVF的独立预测因素。rVF组的院内死亡率为18.3%，无室颤组为3.3%（p <0.001），但rVF不是院内死亡的独立预测因素。总之，STEMI患者PCI前ST段抬高的幅度可独立预测rVF，在围手术期心律失常风险评估中应予以考虑。尽管rVF患者的院内死亡率较高，但rVF本身对预后没有独立的预后价值。
