Volpi A, Cavalli A, Santoro L, Negri E
Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy.
Am J Cardiol. 1998 Aug 1;82(3):265-71. doi: 10.1016/s0002-9149(98)00336-1.
Primary ventricular fibrillation (VF) complicating acute myocardial infarction (MI) predicts short-term mortality. The broad category of patients with primary VF might include subgroups with different outcomes. It is still not certain whether early-onset (< or =4 hours) primary VF is a risk predictor, and information on correlates of these early fibrillations is scarce. This study sought to prospectively analyze the incidence and prognosis of early, as opposed to late (time window >4 to 48 hours) primary VF and retrospectively identify predisposing factors for early-onset primary VF. We analyzed the incidence and recurrence rate of early and late primary VF in 9,720 patients with a first acute MI, treated with thrombolytics, enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-2 trial. The independent prognostic significance of early and late primary VF was assessed by logistic regression analysis. The incidence rates of early and late primary VF were 3.1% and 0.6%, respectively; recurrence rates were 11% and 15%, respectively. The 2 variables most closely related to early primary VF were hypokalemia and systolic blood pressure < 120 mm Hg on admission. Patients with early primary VF had a more complicated in-hospital course than matched controls. Both early (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.48 to 4.13) and late primary VF (OR 3.97, 95% CI 1.51 to 10.48) were independent predictors of in-hospital mortality. Postdischarge to 6-month death rates were similar for both primary VF subgroups and controls. Primary VF, irrespective of its timing, was an independent predictor of in-hospital mortality. Postdischarge to 6-month prognosis was unaffected by the occurrence of either early or late primary VF.
原发性心室颤动（VF）并发急性心肌梗死（MI）可预测短期死亡率。原发性VF患者这一广泛类别可能包括具有不同预后的亚组。早期发作（≤4小时）的原发性VF是否为风险预测因素仍不确定，且关于这些早期颤动相关因素的信息很少。本研究旨在前瞻性分析早期与晚期（时间窗＞4至48小时）原发性VF的发生率和预后，并回顾性确定早期发作原发性VF的易感因素。我们分析了9720例首次急性MI且接受溶栓治疗的患者中早期和晚期原发性VF的发生率和复发率，这些患者参加了意大利心肌梗死存活研究组（GISSI）-2试验。通过逻辑回归分析评估早期和晚期原发性VF的独立预后意义。早期和晚期原发性VF的发生率分别为3.1%和0.6%；复发率分别为11%和15%。与早期原发性VF最密切相关的两个变量是低钾血症和入院时收缩压＜120 mmHg。早期原发性VF患者的住院过程比匹配的对照组更复杂。早期（比值比[OR]2.47，95%置信区间[CI]1.48至4.13）和晚期原发性VF（OR 3.97，95%CI 1.51至10.48）均为住院死亡率的独立预测因素。两个原发性VF亚组和对照组出院后至6个月的死亡率相似。原发性VF，无论其发生时间如何，都是住院死亡率的独立预测因素。早期或晚期原发性VF的发生均不影响出院后至6个月的预后。
