Vaage-Nilsen M, Rasmussen V, Hansen J F, Hagerup L, Sørensen M B, Pedersen-Bjergaard O, Mellemgaard K, Holländer N H, Nielsen I, Sigurd B M
Department of Cardiology B Rigshospitalet, Copenhagen, Denmark.
Clin Cardiol. 1998 Dec;21(12):905-11. doi: 10.1002/clc.4960211209.
Ventricular ectopy early after an acute myocardial infarction (AMI) has previously been demonstrated to predict mortality. Less information is available about the prognostic implications of ventricular ectopy occurring late after an AMI, and no information is available about the prognostic implication of the development of ventricular ectopy during the first year after an AMI.
The purpose of the present prospectively conducted trial, a part of the Danish Verapamil Infarction Trial II (DAVIT II), was to evaluate the prognostic implication of (1) ventricular premature complexes (VPCs) recorded by 24-h Holter monitoring 1 week, 1 month, and 16 months after an AMI; and (2) development of > 10 VPCs/h or of any complex ventricular ectopy, that is, pairs, more than two types of VPCs, ventricular tachycardia, or > 10 VPCs/h during follow-up after an AMI.
Patients were monitored 1 week (n = 250), 1 month (n = 210), and 16 months (n = 201) after AMI.
Multivariate analyses based on history, clinical findings, and ventricular ectopy showed the following results: After 1 week, > 10 VPCs/h (p = 0.0006) and heart failure (p < 0.007); after 1 month, > 10 VPCs/h (p = 0.003) and resting heart rate (p < 0.02); and after 16 months, ventricular tachycardia (p = 0.002) independently predicted long-term mortality. Mortality was significantly predicted by the development of > 10 VPCs/h from 1 week to 1 month (p = 0.003) and 16 months (p = 0.03), and from 1 to 16 months (p = 0.007) after AMI, as well as by the development of any complex ventricular ectopy from 1 week to 1 month (p = 0.02) and 16 months (p = 0.01), and from 1 to 16 months (p = 0.04) after AMI.
The present study demonstrated that 1 week and 1 month after an AMI the quantity of VPCs, that is, > 10 VPCs/h, predicted mortality, whereas 16 months after an AMI the quality of VPCs, that is, ventricular tachycardia, predicted mortality.
既往研究表明，急性心肌梗死（AMI）后早期出现的室性早搏可预测死亡率。关于AMI后晚期出现室性早搏的预后意义，相关信息较少，且尚无关于AMI后第一年出现室性早搏进展的预后意义的信息。
本前瞻性试验是丹麦维拉帕米梗死试验II（DAVIT II）的一部分，目的是评估以下情况的预后意义：（1）AMI后1周、1个月和16个月通过24小时动态心电图监测记录的室性早搏（VPC）；（2）AMI后随访期间VPC每小时超过10次或出现任何复杂性室性早搏，即成对早搏、超过两种类型的VPC、室性心动过速或每小时超过10次VPC。
对AMI后1周（n = 250）、1个月（n = 210）和16个月（n = 201）的患者进行监测。
基于病史、临床发现和室性早搏的多因素分析显示以下结果：1周后，每小时超过10次VPC（p = 0.0006）和心力衰竭（p < 0.007）；1个月后，每小时超过10次VPC（p = 0.003）和静息心率（p < 0.02）；16个月后，室性心动过速（p = 0.002）可独立预测长期死亡率。AMI后1周与1个月（p = 0.003）、1周与16个月（p = 0.03）以及1个月与16个月（p = 0.007）期间每小时超过10次VPC的进展，以及AMI后1周与1个月（p = 0.02）、1周与16个月（p = 0.01）以及1个月与16个月（p = 0.04）期间任何复杂性室性早搏的进展，均显著预测死亡率。
本研究表明，AMI后1周和1个月时，VPC的数量，即每小时超过10次VPC，可预测死亡率，而AMI后16个月时，VPC的性质，即室性心动过速，可预测死亡率。
