Wu Xi, Wu Mingxing, Huang Haobo, Liu Zhe, Huang He, Wang Lei
Department of Cardiology, Xiangtan Central Hospital (the affiliated hospital of Hunan University), Xiangtan, Hunan, 411100, People's Republic of China.
BMC Cardiovasc Disord. 2025 Jul 5;25(1):494. doi: 10.1186/s12872-025-04953-9.
Reperfusion-induced ventricular arrhythmias (VAs) are a common yet under-recognized complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Their clinical impact and predictors remain incompletely understood.
This study aimed to evaluate the incidence, distribution, risk factors, and prognostic significance of reperfusion-related VAs in a contemporary STEMI population treated with PPCI.
We retrospectively analyzed 736 STEMI patients who underwent PPCI between 2018 and 2023. Continuous telemetry monitoring was used to detect VAs, including premature ventricular contractions (PVCs), accelerated idioventricular rhythm (AIVR), non-sustained ventricular tachycardia (NSVT), sustained ventricular tachycardia (VT), and ventricular fibrillation (VF). Logistic regression models were applied to identify independent predictors of VA occurrence and assess their association with in-hospital major adverse cardiovascular events (MACE).
VAs were observed in 48.8% of patients, with frequent PVCs (43.7%) and AIVR (18.9%) being the predominant subtypes. Multivariate analysis identified extensive anterior infarction and left anterior descending artery (LAD) involvement as independent predictors of VA development ( = 0.032). The presence of VAs was significantly associated with higher rates of in-hospital MACE, including cardiac death, recurrent myocardial infarction, and urgent target vessel revascularization.
Reperfusion-related VAs are common following PPCI for STEMI and carry a substantial adverse prognostic impact. Early identification of high-risk patients based on infarct characteristics and continuous arrhythmia monitoring is essential to improve clinical outcomes. Further prospective studies are warranted to refine management strategies targeting reperfusion arrhythmias.
再灌注诱导的室性心律失常（VAs）是接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高型心肌梗死（STEMI）患者中常见但未得到充分认识的并发症。其临床影响和预测因素仍未完全明确。
本研究旨在评估当代接受PPCI治疗的STEMI患者中与再灌注相关的室性心律失常的发生率、分布、危险因素及预后意义。
我们回顾性分析了2018年至2023年间接受PPCI的736例STEMI患者。采用连续遥测监测来检测室性心律失常，包括室性早搏（PVCs）、加速性室性自主心律（AIVR）、非持续性室性心动过速（NSVT）、持续性室性心动过速（VT）和心室颤动（VF）。应用逻辑回归模型来确定室性心律失常发生的独立预测因素，并评估它们与院内主要不良心血管事件（MACE）的关联。
48.8%的患者观察到室性心律失常，频发室性早搏（43.7%）和加速性室性自主心律（18.9%）是主要亚型。多变量分析确定广泛前壁梗死和左前降支（LAD）受累是室性心律失常发生的独立预测因素（P = 0.032）。室性心律失常的存在与较高的院内MACE发生率显著相关，包括心源性死亡、再发性心肌梗死和紧急靶血管血运重建。
STEMI患者接受PPCI后，与再灌注相关的室性心律失常很常见，并具有重大的不良预后影响。基于梗死特征早期识别高危患者并持续进行心律失常监测对于改善临床结局至关重要。有必要进行进一步的前瞻性研究以完善针对再灌注心律失常的管理策略。
