First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Cardiology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany.
Heart Vessels. 2021 Nov;36(11):1701-1711. doi: 10.1007/s00380-021-01844-9. Epub 2021 Apr 26.
Both acute myocardial infarction complicated by ventricular tachyarrhythmias (AMI-VTA) and electrical storm (ES) represent life-threatening clinical conditions. However, a direct comparison of both sub-groups regarding prognostic endpoints has never been investigated. All consecutive implantable cardioverter-defibrillator (ICD) recipients were included retrospectively from 2002 to 2016. Patients with ES apart from AMI (ES) were compared to patients with AMI accompanied by ventricular tachyarrhythmias (AMI-VTA). The primary endpoint was all-cause mortality at 3 years, secondary endpoints were in-hospital mortality, rehospitalization rates and major adverse cardiac event (MACE) at 3 years. A total of 198 consecutive ICD recipients were included (AMI-VTA: 56%; ST-segment elevation myocardial infarction (STEMI): 22%; non-ST-segment myocardial infarction (NSTEMI) 78%; ES: 44%). ES patients were older and had higher rates of severely reduced left ventricular ejection fraction (LVEF) < 35%. ES was associated with increased all-cause mortality at 3 years (37% vs. 19%; p = 0.001; hazard ratio [HR] = 2.242; 95% CI 2.291-3.894; p = 0.004) and with increased risk of first cardiac rehospitalization (44% vs. 12%; p = 0.001; HR = 4.694; 95% CI 2.498-8.823; p = 0.001). This worse prognosis of ES compared to AMI-VTA was still evident after multivariable adjustment (long-term all-cause mortality: HR = 2.504; 95% CI 1.093-5.739; p = 0.030; first cardiac rehospitalization: HR = 2.887; 95% CI 1.240-6.720; p = 0.014). In contrast, the rates of MACE (40% vs. 32%; p = 0.326) were comparable in both groups. At long-term follow-up of 3 years, ES was associated with higher rates of all-cause mortality and rehospitalization compared to patients with AMI-VTA.
急性心肌梗死伴室性心律失常（AMI-VTA）和电风暴（ES）均为危及生命的临床情况。然而，目前尚未对这两个亚组的预后终点进行直接比较。
回顾性纳入 2002 年至 2016 年所有连续植入式心脏复律除颤器（ICD）受者。ES 患者（除 AMI 之外）与 AMI 伴发室性心律失常（AMI-VTA）患者进行比较。主要终点为 3 年全因死亡率，次要终点为 3 年住院死亡率、再住院率和主要不良心脏事件（MACE）。共纳入 198 例连续 ICD 受者（AMI-VTA：56%；ST 段抬高型心肌梗死（STEMI）：22%；非 ST 段抬高型心肌梗死（NSTEMI）：78%；ES：44%）。ES 患者年龄较大，左心室射血分数（LVEF）严重降低（＜35%）的比例更高。ES 与 3 年全因死亡率增加相关（37% vs. 19%；p=0.001；风险比[HR]为 2.242；95%置信区间为 2.291-3.894；p=0.004），与首次心脏再住院风险增加相关（44% vs. 12%；p=0.001；HR 为 4.694；95%置信区间为 2.498-8.823；p=0.001）。
在多变量调整后，ES 与 AMI-VTA 相比预后更差的情况仍然明显（长期全因死亡率：HR 为 2.504；95%置信区间为 1.093-5.739；p=0.030；首次心脏再住院：HR 为 2.887；95%置信区间为 1.240-6.720；p=0.014）。相反，两组间 MACE 发生率（40% vs. 32%；p=0.326）相当。
在 3 年的长期随访中，与 AMI-VTA 患者相比，ES 患者的全因死亡率和再住院率更高。
