Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China; Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Hong Kong SAR, China.
Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
Heart Rhythm. 2018 Jun;15(6):822-829. doi: 10.1016/j.hrthm.2018.02.016. Epub 2018 Feb 14.
The prognostic implication of early ventricular tachyarrhythmias (VTs) after acute coronary syndrome (ACS) remains unclear.
We sought to investigate the clinical outcomes of early monomorphic and non-monomorphic VTs that occur within 48 hours in patients after ACS.
We retrospectively reviewed the clinical outcomes of 2033 [mean age 67.0 ± 13.4 years; 1486 (73.1%) men] consecutive patients who presented with ACS from 2004 to 2015.
A total of 67 (3.3%) and 90 (4.4%) patients developed early monomorphic or non-monomorphic VT, respectively. Killip class IV (odds ratio [OR] 3.05; 95% confidence interval [CI] 1.47-6.36; P < .01), creatine kinase level (OR 1.01; 95% CI 1.00-1.02 per 100 IU/L; P = .01), and left ventricular ejection fraction (OR 0.96; 95% CI 0.94-0.99; P < .01) were independently associated with early monomorphic VT, whereas age (OR 0.98; 95% CI 0.97-0.99; P = .04), ST elevated myocardial infarction (OR 3.53; 95% CI 1.71-7.27; P < .01), Killip class IV (OR 4.91; 95% CI 2.76-8.74; P < .01), diabetes mellitus (OR 0.48; 95% CI 0.28-0.81; P < .01), and left ventricular ejection fraction (OR 0.97; 95% CI 0.95-0.99; P < .01) were independently associated with early non-monomorphic VT. More patients with early monomorphic VT (n = 22 [32.8%]) died in hospital than those with non-monomorphic VT (n = 16 [17.8%]) or without early VT (n = 133 [7.1%]; P < .01). After a mean follow-up of 67.8 ± 43.2 months, 21 patients with early monomorphic VT (46.7%), 22 patients with early non-monomorphic VT (29.7%), and 552 patients without early VT (31.7%) died. Both early monomorphic and non-monomorphic VTs were associated with a long-term increase in sudden arrhythmic deaths and recurrent VTs. Nevertheless, only early monomorphic VT was shown to independently predict overall survival (hazard ratio 1.62; 95% CI 1.03-2.55; P = .04).
Early monomorphic VT, but not early non-monomorphic VT, independently predicted all-cause mortality in patients with ACS who survived to hospital discharge.
急性冠状动脉综合征（ACS）后早期室性心动过速（VTs）的预后意义尚不清楚。
我们旨在研究 ACS 后 48 小时内发生的早期单形性和非单形性 VT 的临床结局。
我们回顾性分析了 2004 年至 2015 年期间连续就诊的 2033 例 ACS 患者（平均年龄 67.0±13.4 岁，1486 例[73.1%]为男性）的临床结局。
共有 67（3.3%）和 90（4.4%）例患者分别发生早期单形性或非单形性 VT。Killip 分级 IV（比值比[OR]3.05；95%置信区间[CI]1.47-6.36；P<.01）、肌酸激酶水平（OR 1.01；95%CI 1.00-1.02 每 100IU/L；P=0.01）和左心室射血分数（OR 0.96；95%CI 0.94-0.99；P<.01）与早期单形性 VT 独立相关，而年龄（OR 0.98；95%CI 0.97-0.99；P=0.04）、ST 段抬高型心肌梗死（OR 3.53；95%CI 1.71-7.27；P<.01）、Killip 分级 IV（OR 4.91；95%CI 2.76-8.74；P<.01）、糖尿病（OR 0.48；95%CI 0.28-0.81；P<.01）和左心室射血分数（OR 0.97；95%CI 0.95-0.99；P<.01）与早期非单形性 VT 独立相关。更多早期单形性 VT 患者（n=22[32.8%]）在院内死亡，而非单形性 VT 患者（n=16[17.8%]）或无早期 VT 患者（n=133[7.1%]）死亡较少（P<.01）。在平均随访 67.8±43.2 个月后，21 例早期单形性 VT（46.7%）、22 例早期非单形性 VT（29.7%）和 552 例无早期 VT（31.7%）患者死亡。早期单形性和非单形性 VT 均与心律失常性死亡和复发性 VT 的长期增加相关。然而，只有早期单形性 VT 独立预测了 ACS 患者的总生存（风险比 1.62；95%CI 1.03-2.55；P=0.04）。
ACS 后存活至出院的患者中，早期单形性 VT 而非早期非单形性 VT 独立预测全因死亡率。
