Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, United States of America.
Epidemiological Cardiology Research Center (EPICARE), Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
J Electrocardiol. 2023 Mar-Apr;77:41-45. doi: 10.1016/j.jelectrocard.2022.12.004. Epub 2022 Dec 28.
Predictors for increased stroke mortality identify those who may need closer monitoring and better hospital care. While the link between premature ventricular complexes (PVCs) and incident ischemic stroke has been reported, studies on the association with fatal stroke are non-existent.
We examined the association of PVCs with stroke mortality in 8047 participants (56.5 ± 0.39 years, 53% women, 80.9% Non-Hispanic Whites) without prior history of stroke from the Third National Health and Nutrition Examination Survey. National Death Index was used to identify the date and cause of death. PVCs were detected from 12‑lead standard electrocardiograms. Cox proportional hazard analysis was used to examine the association between any PVC with stroke mortality.
Approximately 2.1% (n = 134) participants had PVCs at baseline. Over a median follow-up of 22 years, 337 fatal strokes occurred. More strokes occurred in participants with baseline PVCs compared to those without (unadjusted cumulative incidence of stroke 9.5% vs. 2.5% respectively, p-value 0.001). In a multivariable-adjusted model, the presence of PVC was associated with an increased risk of stroke mortality (HR (95%CI): 2.50 (1.15-5.43). This association was stronger in participants with coronary heart disease (CHD) than those without it (HR (95%CI): 5.98 (2.2-16.2) vs. 1.97 (0.75-5.1) respectively; interaction-p = 0.008).
PVCs are associated with an increased risk of stroke mortality, especially among individuals with CHD. Whether improved hospital care or modifying PVCs could change outcomes should be examined in prospective studies.
预测增加中风死亡率的因素可以确定哪些患者需要更密切的监测和更好的医院护理。虽然已有研究报道了过早的心室复合波（PVCs）与缺血性中风事件之间的联系，但目前尚无研究探讨其与致命性中风之间的关联。
我们研究了 8047 名参与者（56.5±0.39 岁，53%为女性，80.9%为非西班牙裔白人）的 PVCs 与中风死亡率之间的关系，这些参与者在研究开始前均无中风病史。我们利用国家死亡索引确定了死亡日期和死因。PVCs 是通过 12 导联标准心电图检测到的。我们使用 Cox 比例风险分析来检验任何 PVC 与中风死亡率之间的关系。
大约 2.1%（n=134）的参与者在基线时有 PVCs。在中位随访 22 年期间，有 337 例致命性中风发生。与无 PVCs 的参与者相比，基线时有 PVCs 的参与者发生更多的中风（未经校正的中风累积发生率分别为 9.5%和 2.5%，p 值<0.001）。在多变量调整模型中，存在 PVC 与中风死亡率增加相关（HR（95%CI）：2.50（1.15-5.43）。在患有冠心病（CHD）的参与者中，这种相关性更强，而在无 CHD 的参与者中则较弱（HR（95%CI）：5.98（2.2-16.2）与 1.97（0.75-5.1）；交互作用 p=0.008）。
PVCs 与中风死亡率增加相关，尤其是在患有 CHD 的患者中。在前瞻性研究中应进一步探讨改善医院护理或改变 PVCs 是否可以改变结局。
