Singh Balbir, Rao Hygriv B, Pandurangi Ulhas, Manjunath C N, Sharma Gautam, Naik Ajay, Thachil Ajit, Chandra Sharad, Rajan Vinayakrishnan, Gerritse Bart, Kaul Upendra, Sinha Nakul, Narasimhan C, Jain R K Premchand, Saxena Anil
Max Super Speciality Hospital, New Delhi, India.
Krishna Institute of Medical Sciences, Hyderabad, India.
Indian Heart J. 2022 May-Jun;74(3):194-200. doi: 10.1016/j.ihj.2022.04.010. Epub 2022 Apr 29.
Sudden cardiac death (SCD) continues to be a devastating complication amongst survivors of myocardial infarction (MI). Mortality is high in the initial months after MI. The aims of the INSPIRE-ELR study were to assess the proportion of patients with significant arrhythmias early after MI and the association with mortality during 12 months of follow-up.
The study included 249 patients within 14 days after MI with left ventricular ejection fraction (LVEF) ≤35% at discharge in 11 hospitals in India. Patients received a wearable external loop recorder (ELR) 5 ± 3 days after MI to monitor arrhythmias for 7 days.
Patients were predominantly male (86%) with a mean age of 56 ± 12 years. In 82%, reperfusion had been done and all received standard of care cardiovascular medications at discharge. LVEF was 32.2 ± 3.9%, measured 5.1 ± 3.0 days after MI. Of the 233 patients who completed monitoring (7.1 ± 1.5 days), 81 (35%) experienced significant arrhythmias, including Ventricular Tachycardia/Fibrillation (VT/VF): 10 (4.3%); frequent Premature Ventricular Contractions (PVCs): 65 (28%); Atrial Fibrillation (AF): 8 (3.4%); chronic atrial flutter: 4 (1.7%); 2nd or 3rd degree Atrioventricular (AV) block: 4 (1.7%); and symptomatic bradycardia: 8 (3.4%). In total, 26 patients died. Mortality was higher in patients with clinically significant arrhythmia (at 12 months: 23.6% vs 4.8% with 19 vs 7 deaths, hazard ratio (HR) = 5.5, 95% confidence interval (CI) 2.3 to 13.0, p < 0.0001). Excluding 7 deaths during ELR monitoring, HR = 4.5, p < 0.001.
ELR applied in patients with acute MI and LV dysfunction at the time of discharge identifies patients with high mortality risk.
心脏性猝死（SCD）仍是心肌梗死（MI）幸存者中一种极具破坏性的并发症。心肌梗死后最初几个月的死亡率很高。INSPIRE-ELR研究的目的是评估心肌梗死后早期发生严重心律失常的患者比例以及与随访12个月期间死亡率的关联。
该研究纳入了印度11家医院中249例心肌梗死后14天内出院时左心室射血分数（LVEF）≤35%的患者。患者在心肌梗死后5±3天接受可穿戴式体外循环记录仪（ELR），以监测7天的心律失常情况。
患者以男性为主（86%），平均年龄为56±12岁。82%的患者进行了再灌注治疗，所有患者出院时均接受了标准的心血管药物治疗。心肌梗死后5.1±3.0天测得LVEF为32.2±3.9%。在完成监测的233例患者中（7.1±1.5天），81例（35%）发生了严重心律失常，包括室性心动过速/心室颤动（VT/VF）：10例（4.3%）；频发室性早搏（PVC）：65例（28%）；心房颤动（AF）：8例（3.4%）；慢性心房扑动：4例（1.7%）；二度或三度房室传导阻滞：4例（1.7%）；有症状的心动过缓：8例（3.4%）。共有26例患者死亡。发生具有临床意义心律失常的患者死亡率更高（12个月时：23.6%对4.8%，死亡人数分别为19例和7例，风险比（HR）=5.5，95%置信区间（CI）2.3至13.0，p<0.0001）。排除ELR监测期间的7例死亡病例后，HR=4.5，p<0.001。
出院时应用于急性心肌梗死和左心室功能不全患者的ELR可识别出高死亡风险患者。
