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心肌梗死患者的心脏性猝死:1.5 级一级预防。

Sudden cardiac death in patients with myocardial infarction: 1.5 primary prevention.

机构信息

Dalian Medical University, 116044 Dalian, Liaoning, China.

Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 200092 Shanghai, China.

出版信息

Rev Cardiovasc Med. 2021 Sep 24;22(3):807-816. doi: 10.31083/j.rcm2203087.

Abstract

Sudden cardiac death (SCD) is one of the most common causes of death in the world. Coronary heart disease (CHD) is the root cause of most patients with SCD, and myocardial infarction (MI) is the main cause of SCD among all types of CHD. Early identification of high-risk patients after an MI, and the application of related prevention strategies and disease-specific treatments will be the key to reduce SCD. The mechanism of SCD after MI varies over time, and the relevant risk prediction indicators are also dynamic and different. In the existing guidelines for MI patients, the static and slightly single stratification of primary (PP) and secondary (SP) prevention has significant room for improvement. The 1.5 primary prevention (1.5PP) is defined as patients with PP who also had the following risk factors: non-sustained ventricular tachycardia (NSVT), frequent premature ventricular contractions (PVCs), severe heart failure (left ventricular ejection fraction, LVEF <25%), and syncope or pre-syncope. The emergence of 1.5PP has provided a new method for the stratification and management of SCD after an MI.

摘要

心源性猝死(SCD)是世界上最常见的死亡原因之一。冠心病(CHD)是大多数 SCD 患者的根本原因,而心肌梗死(MI)是所有类型 CHD 中 SCD 的主要原因。早期识别 MI 后高危患者,并应用相关预防策略和疾病特异性治疗将是降低 SCD 的关键。MI 后 SCD 的发生机制随时间而变化,相关风险预测指标也是动态且不同的。在现有的 MI 患者指南中,对一级(PP)和二级(SP)预防的静态和稍单一的分层有很大的改进空间。1.5 级预防(1.5PP)定义为具有以下危险因素的 PP 患者:非持续性室性心动过速(NSVT)、频发室性期前收缩(PVCs)、严重心力衰竭(左心室射血分数,LVEF<25%)和晕厥或先兆晕厥。1.5PP 的出现为 MI 后 SCD 的分层和管理提供了一种新方法。

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