自发性冠状动脉夹层伴室性心动过速/颤动患者的住院期间和长期结局。
In-hospital and long-term outcomes among patients with spontaneous coronary artery dissection presenting with ventricular tachycardia/fibrillation.
机构信息
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
Heart Rhythm. 2020 Nov;17(11):1864-1869. doi: 10.1016/j.hrthm.2020.06.019. Epub 2020 Jun 24.
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-age women. Ventricular tachycardia/ventricular fibrillation (VT/VF) may complicate acute SCAD presentations, and the long-term outcomes are unknown.
OBJECTIVE
The purpose of this study was to report the outcomes of SCAD patients presenting with VT/VF.
METHODS
We analyzed our prospective Canadian SCAD registries for patients presenting with VT/VF during index hospitalization. Long-term outcomes including VT/VF and cardiac arrest were collected. Univariate and multivariable analyses were performed to identify predictors of VT/VF at follow-up.
RESULTS
Among 1056 consecutive SCAD patients, 84 (8.0%) presented with VT/VF, and 8 underwent implantable cardioverter-defibrillator (ICD) insertion. Patients with VT/VF during index hospitalization were younger (49.3 vs 52.0 years; P = .019) and were more likely to have ST-elevation MI, lower left ventricular ejection fraction (LVEF), and left main dissection (all P <.001). Initial VT/VF was associated with in-hospital events, including recurrent MI, unplanned revascularization, heart failure, ICD insertion, and in-hospital death (all P <.05). At mean follow-up of 4.8 ± 3.3 years, 8 patients suffered VT/VF (time to event 5.2 ± 6.2 years); 5 of 8 patients had VT/VF on initial SCAD presentation, and 1 of 8 had undergone ICD insertion. Predictors of VT/VF during follow-up included LVEF <50%, LVEF <35%, peripartum SCAD, unplanned revascularization, repeat MI, heart failure, and initial VT/VF. Multivariable analysis showed initial VT/VF (odds ratio [OR] 9.5; 95% confidence interval [CI] 2.0-44; P = .004) and LVEF <50% (OR 12.9; 95% CI 1.5-111; P = .019) were independent predictors of VT/VF at follow-up.
CONCLUSION
SCAD patients presenting with VT/VF were at greater risk for in-hospital events and recurrent VF/VT at follow-up. Both VT/VF and LVEF <50% were independent predictors of subsequent VT/VF.
背景
自发性冠状动脉夹层（SCAD）是中青年女性心肌梗死（MI）的重要原因。室性心动过速/心室颤动（VT/VF）可能使急性 SCAD 发作复杂化，其长期预后尚不清楚。
目的
本研究旨在报告伴有 VT/VF 的 SCAD 患者的结局。
方法
我们分析了前瞻性加拿大 SCAD 登记处中在住院期间出现 VT/VF 的患者。收集了包括 VT/VF 和心脏骤停在内的长期结局。进行了单变量和多变量分析，以确定随访时 VT/VF 的预测因素。
结果
在 1056 例连续 SCAD 患者中，84 例（8.0%）在住院期间出现 VT/VF，8 例植入了植入式心脏复律除颤器（ICD）。住院期间发生 VT/VF 的患者年龄较小（49.3 岁 vs. 52.0 岁；P =.019），更有可能出现 ST 段抬高型心肌梗死、较低的左心室射血分数（LVEF）和左主干夹层（均 P<.001）。初始 VT/VF 与院内事件相关，包括复发性 MI、计划外血运重建、心力衰竭、ICD 植入和院内死亡（均 P<.05）。在平均 4.8±3.3 年的随访中，8 例患者发生 VT/VF（事件时间为 5.2±6.2 年）；8 例中有 5 例在初始 SCAD 时发生 VT/VF，1 例接受了 ICD 植入。随访期间 VT/VF 的预测因素包括 LVEF<50%、LVEF<35%、围产期 SCAD、计划外血运重建、再发 MI、心力衰竭和初始 VT/VF。多变量分析显示，初始 VT/VF（优势比 [OR] 9.5；95%置信区间 [CI] 2.0-44；P =.004）和 LVEF<50%（OR 12.9；95% CI 1.5-111；P =.019）是随访时 VT/VF 的独立预测因素。
结论
伴有 VT/VF 的 SCAD 患者住院期间发生事件和随后发生 VT/VF 的风险更高。VT/VF 和 LVEF<50%均是随后发生 VT/VF 的独立预测因素。
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