1 First Department of Medicine Faculty of Medicine Mannheim University Medical Centre Mannheim (UMM) University of Heidelberg European Center for AngioScience (ECAS) Mannheim Germany.
2 DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany.
J Am Heart Assoc. 2018 Oct 2;7(19):e010004. doi: 10.1161/JAHA.118.010004.
Background The study sought to assess the prognostic impact of acute myocardial infarction ( AMI ) with and without ST -segment-elevation myocardial infarction ( STEMI and NSTEMI ) in patients with ventricular tachyarrhythmias and sudden cardiac arrest ( SCA ) on admission. Methods and Results A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia ( VT ), fibrillation ( VF ), and sudden cardiac arrest ( SCA ) on admission from 2002 to 2016. AMI versus non- AMI and STEMI versus NSTEMI were compared applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic end point defined as long-term all-cause mortality at 2.5 years. Secondary end points were 30 days all-cause mortality, cardiac death at 24 hours, in hospital death, and recurrent percutaneous coronary intervention (re- PCI ) at 2.5 years. In 2813 unmatched high-risk patients with ventricular tachyarrhythmias and SCA , AMI was present in 29% (10% STEMI , 19% NSTEMI ) with higher rates of VF (54% versus 31%) and SCA (35% versus 26%), whereas VT rates were higher in non- AMI (56% versus 30%) ( P < 0.05). AMI -related VT ≥48 hours was associated with higher mortality (log rank P = 0.001). Multivariable Cox regression models revealed non- AMI (hazard ratio = 1.458; P = 0.001) and NSTEMI (hazard ratio = 1.460; P = 0.036) associated with increasing long-term all-cause mortality at 2.5 years, which was also proven after propensity-score matching (non- AMI versus AMI : 55% versus 43%, log rank P = 0.001, hazard ratio = 1.349; NSTEMI versus STEMI : 45% versus 34%, log rank P = 0.047, hazard ratio = 1.372). Secondary end points including 30 days and in-hospital mortality, as well as re- PCI were higher in non- AMI patients. Conclusions In high-risk patients presenting with ventricular tachyarrhythmias and SCA , non- AMI revealed higher mortality than AMI , respectively NSTEMI than STEMI , alongside AMI -related VT ≥48 hours.
背景 本研究旨在评估入院时伴有或不伴有 ST 段抬高型心肌梗死（STEMI 和 NSTEMI）的急性心肌梗死（AMI）对伴有室性心动过速（VT）、心室颤动（VF）和心搏骤停（SCA）的患者的预后影响。
方法和结果 本研究使用了一个大型回顾性登记数据库，纳入了 2002 年至 2016 年期间所有因 VT、VF 和 SCA 入院的连续患者。采用多变量 Cox 回归模型和倾向评分匹配方法比较 AMI 与非 AMI 以及 STEMI 与 NSTEMI，评估主要终点为 2.5 年时的长期全因死亡率。次要终点为 30 天全因死亡率、24 小时内心脏性死亡、住院期间死亡和 2.5 年时再次经皮冠状动脉介入治疗（re-PCI）。在 2813 例伴有室性心律失常和 SCA 的高危患者中，AMI 的发生率为 29%（10%为 STEMI，19%为 NSTEMI），VF（54%比 31%）和 SCA（35%比 26%）的发生率较高，而非 AMI 的 VT 发生率较高（56%比 30%）（P<0.05）。AMI 相关 VT ≥48 小时与死亡率较高相关（log rank P=0.001）。多变量 Cox 回归模型显示非 AMI（风险比=1.458；P=0.001）和 NSTEMI（风险比=1.460；P=0.036）与 2.5 年时的长期全因死亡率增加相关，这一结果在倾向评分匹配后也得到了证实（非 AMI 与 AMI：55%比 43%，log rank P=0.001，风险比=1.349；NSTEMI 与 STEMI：45%比 34%，log rank P=0.047，风险比=1.372）。非 AMI 患者的次要终点包括 30 天和住院期间死亡率以及再次 PCI 的发生率更高。
结论 在伴有 VT 和 SCA 的高危患者中，非 AMI 患者的死亡率高于 AMI，分别为 NSTEMI 高于 STEMI，同时 AMI 相关 VT ≥48 小时也与死亡率相关。
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