Bui An H, Cannon Christopher P, Steg Philippe Gabriel, Storey Robert F, Husted Steen, Guo Jianping, Im KyungAh, James Stefan K, Michelson Eric L, Himmelmann Anders, Held Claes, Varenhorst Christoph, Wallentin Lars, Scirica Benjamin M
For the author affiliations, please see the Appendix section.
Circ Arrhythm Electrophysiol. 2016 Feb;9(2):e002951. doi: 10.1161/CIRCEP.115.002951.
Nonsustained ventricular tachycardia (NSVT) is common after acute coronary syndrome (ACS) and a marker of increased risk of arrhythmogenic death. However, the prognostic significance of NSVT when evaluated with other contemporary risk markers and at later time points after ACS remains uncertain.
In the Platelet Inhibition and Patient Outcomes (PLATO) trial, continuous ECGs were performed during the first 7 days after ACS (n=2866) and repeated for another 7 days at day 30 (n=1991). Median follow-up was 1 year. There was a time-varying interaction between NSVT and cardiovascular death such that NSVT was significantly associated with increased risk within the first 30 days after randomization (22/999 [2.2%] versus 16/1825 [0.9%]; adjusted hazard ratio, 2.84; 95% confidence interval, 1.39-5.79; P=0.004) but not after 30 days (28/929 [3.0%] versus 42/1734 [2.4%]; P=0.71). Detection of NSVT during the convalescent phase (n=428/1991; 21.5%) was also associated with an increased risk of cardiovascular death, and was most marked within the first 2 months after detection (1.9% versus 0.3%; adjusted hazard ratio, 5.48; 95% confidence interval, 1.07-28.20; P=0.01), and then decreasing over time such that the relationship was no longer significant by ≈5 months after ACS.
NSVT occurred frequently during the acute and convalescent phases of ACS. The risk of cardiovascular death associated with NSVT was the greatest during the first 30 days after presentation; however, patients with NSVT detected during the convalescent phase were also at a significantly increased risk of cardiovascular death that persisted for an additional several months after the index event.
http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
非持续性室性心动过速（NSVT）在急性冠状动脉综合征（ACS）后很常见，是心律失常性死亡风险增加的一个标志。然而，当与其他当代风险标志物一起评估以及在ACS后的较晚时间点评估时，NSVT的预后意义仍不确定。
在血小板抑制与患者预后（PLATO）试验中，在ACS后的前7天（n = 2866）进行连续心电图检查，并在第30天重复进行另外7天的检查（n = 1991）。中位随访时间为1年。NSVT与心血管死亡之间存在随时间变化的相互作用，使得NSVT在随机分组后的前30天内与风险增加显著相关（22/999 [2.2%] 对16/1825 [0.9%]；校正风险比，2.84；95%置信区间，1.39 - 5.79；P = 0.004），但在30天后则不然（28/929 [3.0%] 对42/1734 [2.4%]；P = 0.71）。恢复期检测到NSVT（n = 428/1991；21.5%）也与心血管死亡风险增加相关，并且在检测后的前2个月内最为明显（1.9%对0.3%；校正风险比，5.48；95%置信区间，1.07 - 28.20；P = 0.01），然后随时间下降，以至于在ACS后约5个月时这种关系不再显著。
NSVT在ACS的急性期和恢复期频繁发生。与NSVT相关的心血管死亡风险在发病后的前30天内最大；然而，在恢复期检测到NSVT的患者心血管死亡风险也显著增加，并且在索引事件后的几个月内持续存在。
