Araya-Gómez V, González-Hermosillo J A, Casanova Garcés J M, Colín L, Kershenovich S, Iturralde P
Departamento de electrocardiografía y electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Arch Inst Cardiol Mex. 1994 Mar-Apr;64(2):145-59.
Two hundred twenty two consecutive patients with acute myocardial infarction were followed for one year. We evaluated the usefulness of late potentials, the spectral analysis, heart rate variability, infarct-related coronary artery, ejection fraction, arrhythmias during Holter monitoring and other clinical variables as risk markers for developing of ventricular arrhythmias and/or sudden death. Twenty four patients (10.8%) had late arrhythmic events: sudden death in 7, sustained ventricular tachycardia in 15 and unexplained syncope in 2. Late potentials had high sensitivity (94%) and negative predictive value (99%), followed by an occluded related-infarct coronary artery (75% sensitivity and 96% negative predictive value). Complex ventricular arrhythmias during Holter monitoring was the test with the highest specificity (92%). A combination of late potentials plus an occluded infarct-related coronary artery or late potentials plus ejection fraction showed 100% sensitivity with 100% negative predictive value. Of the 16 studied variables, 5 had independent and significative value as a predictor of arrhythmic events, these are, according to the relative risk: late potentials (20.2), ejection fraction less than 40% (12.1), complex arrhythmias during Holter monitoring (7.5), the presence of an occluded infarct-related coronary artery (6.4) and anterior myocardial infarction localization (4.5). We consider, that with a combination of simple methods of assessment, we can select a subgroup of survivors of an acute myocardial infarction at high risk of developing ventricular arrhythmias and sudden death, which also identifies patients with low risk for these complications.
对222例连续的急性心肌梗死患者进行了为期一年的随访。我们评估了晚电位、频谱分析、心率变异性、梗死相关冠状动脉、射血分数、动态心电图监测期间的心律失常以及其他临床变量作为发生室性心律失常和/或猝死风险标志物的有用性。24例患者（10.8%）发生了晚期心律失常事件：7例猝死，15例持续性室性心动过速，2例不明原因晕厥。晚电位具有高敏感性（94%）和阴性预测值（99%），其次是梗死相关冠状动脉闭塞（敏感性75%，阴性预测值96%）。动态心电图监测期间的复杂性室性心律失常是特异性最高的检查（92%）。晚电位加梗死相关冠状动脉闭塞或晚电位加射血分数的组合显示敏感性为100%，阴性预测值为100%。在研究的16个变量中，5个具有作为心律失常事件预测指标的独立且显著的价值，根据相对风险，这些变量依次为：晚电位（20.2）、射血分数小于40%（12.1）、动态心电图监测期间的复杂性心律失常（7.5）、梗死相关冠状动脉闭塞的存在（6.4）和前壁心肌梗死定位（4.5）。我们认为，通过简单评估方法的组合，可以选择出急性心肌梗死幸存者中发生室性心律失常和猝死高风险的亚组，这也能识别出发生这些并发症低风险的患者。
