Sarter B H, Finkle J K, Gerszten R E, Buxton A E
Cardiovascular Section, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
J Am Coll Cardiol. 1996 Jul;28(1):122-9. doi: 10.1016/0735-1097(96)00123-4.
This study sought to determine the long-term risk of sudden cardiac death in patients with hemodynamically stable sustained ventricular tachycardia complicating coronary artery disease.
The prognosis and risk of sudden cardiac death in patients with a history of myocardial infarction and ventricular tachyarrhythmias have not been clearly defined. Prior studies are limited by a short follow-up period and by inclusion of patients with heterogeneous cardiac diseases and presenting arrhythmias.
A retrospective cohort analysis was performed on data from 124 patients, followed up for a mean of 36 +/- 30 months, who received electrophysiologically guided therapy for hemodynamically stable ventricular tachycardia after remote myocardial infarction.
Seventy-eight patients were treated pharmacologically (medical group), and 46 patients underwent map-guided subendocardial resection (surgical group). Nine patients (7.3%) died suddenly, 5 (4.0%) died of noncardiac causes, 9 (7.3%) died of a perioperative complication, and 20 (23.4%) died of other cardiac causes. At 1, 2 and 3 years, sudden death occurred at cumulative rates of 2 +/- 1%, 3 +/- 2% and 7 +/- 3%, whereas total mortality was 20 +/- 4%, 28 +/- 4% and 32 +/- 5% (mean +/- SD). Sudden cardiac death (p = 0.047) and total mortality (p = 0.036) were higher in patients with multivessel disease and were similar for both treatment groups.
Although the overall mortality in postinfarction patients presenting with hemodynamically stable ventricular tachycardia treated with electrophysiologically guided antiarrhythmic therapy is high, the risk of sudden death in these patients appears to be low (average 2.4%/year).
本研究旨在确定冠状动脉疾病合并血流动力学稳定的持续性室性心动过速患者心脏性猝死的长期风险。
有心肌梗死和室性心律失常病史的患者心脏性猝死的预后和风险尚未明确界定。既往研究受随访期短以及纳入患有异质性心脏病和心律失常的患者所限。
对124例患者的数据进行回顾性队列分析，这些患者在陈旧性心肌梗死后因血流动力学稳定的室性心动过速接受了电生理指导治疗，平均随访36±30个月。
78例患者接受药物治疗（药物治疗组），46例患者接受标测引导下的心内膜下切除术（手术治疗组）。9例患者（7.3%）猝死，5例（4.0%）死于非心脏原因，9例（7.3%）死于围手术期并发症，20例（23.4%）死于其他心脏原因。在1年、2年和3年时，心脏性猝死的累积发生率分别为2±1%、3±2%和7±3%，而总死亡率分别为20±4%、28±4%和32±5%（均数±标准差）。多支血管病变患者的心脏性猝死（p = 0.047）和总死亡率（p = 0.036）更高，且两个治疗组相似。
尽管接受电生理指导的抗心律失常治疗的心肌梗死后出现血流动力学稳定的室性心动过速患者的总体死亡率较高，但这些患者的心脏性猝死风险似乎较低（平均每年2.4%）。
