Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France.
Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France.
Arch Cardiovasc Dis. 2022 Jan;115(1):4-16. doi: 10.1016/j.acvd.2021.10.012. Epub 2021 Dec 23.
Ventricular arrhythmias can be life-threatening complications of ST-segment elevation myocardial infarction (STEMI).
To describe the incidence, predictors and in-hospital impact of early ventricular arrhythmia (EVA, occurring<day 2 after STEMI) and late ventricular arrhythmia (LVA, occurring≥day 2 after STEMI) in patients with STEMI.
Data from 13,523 patients enrolled in a prospective registry were analysed. Logistic and Cox regressions were performed to identify predictors of EVA, LVA and in-hospital all-cause mortality. Predictors of LVA were used to build a risk score.
EVA occurred in 678 patients (5%), whereas 120 patients (0.9%) experienced LVA, at a median timing of 3days after STEMI. EVA was associated with a significantly higher risk of all-cause mortality (hazard ratio: 1.44, 95% confidence interval: 1.17-1.76; P=0.001), whereas no association was observed with LVA (hazard ratio 0.86, 95% confidence interval 0.57-1.28; P=0.45). Multivariable predictors of LVA were: age≥65years; serum creatinine≥85μmol/L on admission; pulse pressure≤45mmHg on admission; presence of a Q wave on admission electrocardiogram; Thrombolysis In Myocardial Infarction flow grade<3 after percutaneous coronary intervention; and left ventricular ejection fraction≤45%. The score derived from these variables allowed the classification of patients into four risk categories: low (0-21); low-to-intermediate (22-34); intermediate-to-high (35-44); and high (≥45). Observed LVA rates were 0.2%, 0.3%, 0.9% and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow P=0.23).
EVA is 5-fold more common than LVA in the setting of STEMI, and portends a higher risk of in-hospital all-cause mortality. LVA is mainly associated with the patient's baseline risk profile and surrogate markers of larger infarct size. We developed and internally validated a risk score identifying patients at high risk of LVA for whom early intensive care unit discharge may not be suitable.
室性心律失常是 ST 段抬高型心肌梗死（STEMI）的致命并发症。
描述 STEMI 患者中早期室性心律失常（EVA，发生在 STEMI 后<2 天）和晚期室性心律失常（LVA，发生在 STEMI 后≥2 天）的发生率、预测因素和院内影响。
对前瞻性登记的 13523 例患者的数据进行了分析。使用逻辑回归和 Cox 回归来确定 EVA、LVA 和院内全因死亡率的预测因素。使用 LVA 的预测因素构建风险评分。
678 例（5%）患者发生 EVA，120 例（0.9%）患者发生 LVA，中位时间为 STEMI 后 3 天。EVA 与全因死亡率显著增加相关（风险比：1.44，95%置信区间：1.17-1.76；P=0.001），而与 LVA 无关（风险比 0.86，95%置信区间 0.57-1.28；P=0.45）。LVA 的多变量预测因素为：年龄≥65 岁；入院时血清肌酐≥85μmol/L；入院时脉压≤45mmHg；入院时心电图有 Q 波；经皮冠状动脉介入治疗后心肌梗死溶栓血流分级<3；左心室射血分数≤45%。从这些变量中得出的评分允许将患者分为四个风险类别：低（0-21）；低至中等（22-34）；中至高（35-44）；和高（≥45）。在四个风险类别中，观察到的 LVA 发生率分别为 0.2%、0.3%、0.9%和 2.5%。该模型具有良好的区分度（20 倍交叉验证 C 统计量为 0.76）和适当的校准度（Hosmer-Lemeshow P=0.23）。
STEMI 中 EVA 比 LVA 常见 5 倍，预示着院内全因死亡率更高。LVA 主要与患者的基线风险状况和较大梗死面积的替代标志物相关。我们开发并内部验证了一个风险评分，可识别出发生 LVA 风险较高的患者，这些患者可能不适合早期从重症监护病房出院。
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