ST段抬高型心肌梗死患者早期心室颤动的预后意义

Prognostic implication of early ventricular fibrillation among patients with ST elevation myocardial infarction.

作者信息

Medina-Rodríguez Kristel E, Almendro-Delia Manuel, García-Alcántara Ángel, Arias-Garrido José J, Rodríguez-Yáñez Juan C, Alonso-Muñoz Gemma, de la Chica-Ruiz-Ruano Rafael, Reina-Toral Antonio, Varela-López Antonio, Arboleda-Sánchez José A, Poullet-Brea Ana M, Zaya-Ganfo Benito, Butrón-Calderón Michel, Cristo-Ropero Maria J, Hidalgo-Urbano Rafael, García-Rubira Juan C

机构信息

aDepartment of Cardiology, University Hospital Virgen Macarena, Sevilla bCritical Care Service, University Hospital Virgen de la Victoria, Málaga cCritical Care Unit, Hospital de Antequera dCritical Care Service, University Hospital Regional de Málaga eCritical Care Service, University Hospital Costa del Sol, Málaga fCritical Care Service, University Hospital Jerez gCritical Care Service, University Hospital Puerto Real, Cádiz hCritical Care Service, University Hospital Reina Sofía, Córdoba iCritical Care Service, University Hospital Virgen de las Nieves, Granada, Spain.

出版信息

Coron Artery Dis. 2017 Nov;28(7):570-576. doi: 10.1097/MCA.0000000000000532.

DOI:10.1097/MCA.0000000000000532

PMID:28723829

Abstract

OBJECTIVE

The aim of this study was to analyze the prognosis of patients presenting early ventricular fibrillation (VF) in the setting of ST elevation myocardial infarction (STEMI).

PATIENTS AND METHODS

Among patients included in the ARIAM (Análisis del Retraso en el Infarto Agudo de Miocardio) registry with the diagnosis of STEMI, those who received primary revascularization and were admitted in the first 12 h were analyzed retrospectively.

RESULTS

From January 2007 to January 2012, 8340 patients were included in the STEMI cohort and 680 (8.2%) of them presented with VF before admission to the ICU (VF). This group comprised younger patients with fewer comorbidities. They received more often primary angioplasty (33.7 vs. 24.9%; P<0.001), had more prevalence of Killip class greater than or equal to 2 at admission (37.5 vs. 17.8%; P<0.001), and suffered more often cardiogenic shock (18.5 vs. 5.9%, P<0.001). By logistic regression analysis, VF was associated with a greater in-hospital mortality [odds rate (OR): 2.08, 95% confidence interval (CI): 1.57-2.81, P<0.001]. After a propensity score matching process, VF was associated with in-hospital mortality (OR: 1.53, 95% CI: 1.05-2.25, P=0.028). However, when analyzing patients treated by primary angioplasty, the mortality was not significantly related to VF (OR: 0.86, 95% CI: 0.45-1.61, P=0.628).

CONCLUSION

Our results show that VF before ICU admission was an independent predictor of in-hospital outcome in a cohort of patients in whom fibrinolysis was the most used revascularization therapy. However, this prognostic value was not found in patients treated with primary angioplasty.

摘要

目的

本研究旨在分析ST段抬高型心肌梗死（STEMI）患者出现早期心室颤动（VF）的预后情况。

患者与方法

在ARIAM（急性心肌梗死延迟分析）登记研究中诊断为STEMI的患者中，对那些接受了直接血运重建且在发病12小时内入院的患者进行回顾性分析。

结果

2007年1月至2012年1月期间，STEMI队列共纳入8340例患者，其中680例（8.2%）在入住重症监护病房（ICU）前出现心室颤动（VF）。该组患者较年轻，合并症较少。他们更常接受直接血管成形术（33.7%对24.9%；P<0.001），入院时Killip分级大于或等于2级的患病率更高（37.5%对17.8%；P<0.001），且更常发生心源性休克（18.5%对5.9%，P<0.001）。通过逻辑回归分析，心室颤动与更高的院内死亡率相关[比值比（OR）：2.08，95%置信区间（CI）：1.57 - 2.81，P<0.001]。经过倾向评分匹配后，心室颤动与院内死亡率相关（OR：1.53，95%CI：1.05 - 2.25，P = 0.028）。然而，在分析接受直接血管成形术治疗的患者时，死亡率与心室颤动无显著相关性（OR：0.86，95%CI：0.45 - 1.61，P = 0.628）。