Arribas A, Martín Luengo C, Rodríguez J, Pabón P, Nieto F, Diego M, Castaño L, Santos I, Cascón M, Sala A
Servicio de Cardiología, Hospital Clínico, Salamanca.
Rev Esp Cardiol. 1994 May;47(5):284-93.
To establish a score or arrhythmic pattern for the prediction of long-term cardiac deaths on patients who have survived to the first acute myocardial infarction.
We studied prospectively 200 patients that survived at a first myocardial infarction and in whom ambulatory ECG monitoring during 24 hours between days 7th and 18th (mean 12th) from the infarction was performed. The mean follow-up time was 51 +/- 18 months. The number and type of ventricular arrhythmias were analyzed and a score was measured, accordingly with Castellanos and Lown's classifications. An "arrhythmic pattern" or "total punctuation" was defined and compared among two groups: group 1 > 65 points and group 2 < 65 points.
The differential characteristics of both groups were: age (60 +/- 9 versus 56 +/- 10 years old; p = 0.004); hypertension (63% versus 29%; p < 0.001); clinic stage II-III (23% versus 11%; p = 0.02); echocardiographic ejection fraction (45 +/- 11% versus 50 +/- 10%; p = 0.04); positive exercise testing (73% versus 56%; p = 0.01); arrhythmias on the exercise test (15% versus 25%; p = 0.006). The long-term cardiac mortality was 25% versus 6% (p = 0.01), with an incidence of sudden death of 11% versus 3% (p < 0.05). Specificity, sensibility, positive predictive value and negative predictive value (reference cut point of 100) were 94, 65, 71 and 91%, respectively.
The use of a score of arrhythmic pattern may identify 2 groups of patients with different clinic profiles that probably justify a different long-term prognosis after a first acute myocardial infarction.
建立一种评分或心律失常模式，用于预测首次急性心肌梗死存活患者的长期心脏死亡情况。
我们前瞻性地研究了200例首次心肌梗死存活患者，在梗死第7天至18天（平均第12天）期间对其进行了24小时动态心电图监测。平均随访时间为51±18个月。根据卡斯特利亚诺斯和洛恩的分类方法，分析室性心律失常的数量和类型并进行评分。定义了一种“心律失常模式”或“总评分”，并在两组之间进行比较：第1组>65分，第2组<65分。
两组的差异特征为：年龄（60±9岁对56±10岁；p = 0.004）；高血压（63%对29%；p<0.001）；临床分期II - III期（23%对11%；p = 0.02）；超声心动图射血分数（45±11%对50±10%；p = 0.04）；运动试验阳性（73%对56%；p = 0.01）；运动试验时出现心律失常（15%对25%；p = 0.006）。长期心脏死亡率分别为25%和6%（p = 0.01），猝死发生率分别为11%和3%（p<0.05）。特异性、敏感性、阳性预测值和阴性预测值（参考切点为100）分别为94%、65%、71%和91%。
使用心律失常模式评分可以识别出两组具有不同临床特征的患者，这可能为首次急性心肌梗死后不同的长期预后提供依据。
