Kuchar D L, Thorburn C W, Freund J, Yeates M G, Sammel N L
Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Australia.
Cardiology. 1989;76(1):18-31. doi: 10.1159/000174468.
Signal-averaged electrocardiography, resting radionuclide ventriculography and Holter monitoring were performed prior to hospital discharge, to assess their value in predicting recurrent cardiac events in 210 survivors of acute myocardial infarction. In addition, 153 of these patients also underwent exercise radionuclide ventriculographic assessment. During median follow-up of 14 months (6-24 months), there were 16 cardiac deaths, 15 patients had recurrent infarction and 7 patients represented with symptomatic ventricular tachycardia. Cox regression analysis identified independent predictors of 'ischemic events' (death or re-infarction) as a previous history of infarction (p = 0.01), Killip class III-IV (p = 0.03) and an abnormal exercise radionuclide study (p = 0.04); and predictors of 'arrhythmic events' (sustained ventricular tachycardia or sudden death) as an abnormal signal-averaged electrocardiograph (p = 0.01) and left ventricular ejection fraction less than 40% (p = 0.03). Patients with an abnormal signal-averaged electrocardiograph and reduced left ventricular ejection fraction had a 34% incidence of arrhythmic events during the first 6 months compared with a 4% incidence among patients without late potentials. In those patients who underwent exercise testing and signal averaging, 85% of total cardiac events and all cardiac deaths were predicted by an abnormality of either noninvasive test. In addition, exercise testing and signal-averaged ECG were independent predictors of outcome. Hence, using a combination of noninvasive tests, patients can be stratified according to the risk of recurrent life-threatening cardiac events after myocardial infarction; such patients may be suitable for intensive investigation and considered for trials involving active intervention.
在出院前进行了信号平均心电图、静息放射性核素心室造影和动态心电图监测，以评估它们在预测210例急性心肌梗死幸存者复发性心脏事件中的价值。此外，这些患者中有153例还接受了运动放射性核素心室造影评估。在中位随访14个月（6 - 24个月）期间，有16例心脏死亡，15例患者发生复发性梗死，7例患者出现症状性室性心动过速。Cox回归分析确定“缺血性事件”（死亡或再梗死）的独立预测因素为既往梗死病史（p = 0.01）、Killip III - IV级（p = 0.03）和运动放射性核素检查异常（p = 0.04）；“心律失常事件”（持续性室性心动过速或猝死）的预测因素为信号平均心电图异常（p = 0.01）和左心室射血分数低于40%（p = 0.03）。信号平均心电图异常且左心室射血分数降低的患者在最初6个月内心律失常事件发生率为34%，而无晚期电位的患者发生率为4%。在那些接受运动试验和信号平均检查的患者中，85%的总心脏事件和所有心脏死亡可通过任何一项非侵入性检查异常来预测。此外，运动试验和信号平均心电图是结局的独立预测因素。因此，使用非侵入性检查的组合，可以根据心肌梗死后复发性危及生命的心脏事件风险对患者进行分层；此类患者可能适合进行深入检查，并考虑参与涉及积极干预的试验。
