Impact of revascularization in patients with post-infarction left ventricular aneurysm and ventricular tachyarrhythmia.
Impact of revascularization in patients with post-infarction left ventricular aneurysm and ventricular tachyarrhythmia.
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血运重建对梗死后左室动脉瘤和室性快速心律失常患者的影响。
DOI：
10.1111/anec.12814
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Zhang S
中科院分区：
文献类型：
--
作者：
Ning X;Yang Z;Ye X;Si Y;Wang F;Zhang X;Zhang S
室性心律失常是心肌梗死后左室壁瘤（PI-LVA）患者心源性死亡的主要原因。冠状动脉血运重建术对PI‐LVA室性快速性心律失常患者的影响尚不清楚。本研究旨在研究血运重建治疗对这些患者临床结局的影响。共入组238例PI‐LVA患者，59例患者出现持续性室性心动过速（VT）或室颤（VF）。根据治疗策略（药物或血运重建）和是否存在VT/VF将患者分为4组：第1组（n = 57）：VT/VF−和血运重建−;第2组（n = 122）：VT/VF −和血运重建+;第3组（n = 34）：VT/VF+和血运重建+;第4组（n = 25）：VT/VF+和血运重建−。比较两组患者的临床结局，主要终点为心源性死亡或心脏移植。随访45 ± 16个月，41例（17.2%）患者达到主要终点。Kaplan-Meier分析显示，在VT/VF−患者中，与药物治疗相比，血运重建与更高的心脏存活率相关（对数秩p = .002），但在VT/VF+患者中，血运重建并不能预测更好的心脏结局（对数秩p = .901）。考克斯回归分析显示，PET-EF（HR 4.41，95% CI：1.72-11.36，p = .002）和中度/重度二尖瓣返流（HR 2.32，95% CI：1.02-5.30，p = .046）是VT/VF患者不良心脏结局的独立预测因素。有VT/VF的PI‐LVA患者具有不良心脏结局的高风险，冠状动脉血运重建并不能缓解这种风险，尽管血运重建与无VT/VF的PI‐LVA患者的较高心脏存活率相关。
Ventricular arrhythmia is a leading cause of cardiac death among patients with post‐infarction left ventricular aneurysm (PI‐LVA). The effect of coronary revascularization in PI‐LVA patients with ventricular tachyarrhythmia remains unknown. This study aims to investigate the impact of revascularization therapy on clinical outcomes in these patients. A total of 238 PI‐LVA patients were enrolled, and 59 patients were presented with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Patients were classified into 4 groups by treatment strategies (medical or revascularization) and the presence of VT/VF: group 1 (n = 57): VT/VF− and revascularization−; group 2 (n = 122): VT/VF− and revascularization+; group 3 (n = 34): VT/VF+ and revascularization+; and group 4 (n = 25): VT/VF+ and revascularization‐. The clinical outcomes were compared, and the primary endpoint was cardiac death or heart transplantation. Patients were followed up for 45 ± 16 months, and 41 patients (17.2%) reached the primary endpoint. Kaplan–Meier analysis showed that in VT/VF− patients, revascularization associated with higher cardiac survival compared with medical therapy (log‐rank p = .002), but in VT/VF+ patients, revascularization did not predict better cardiac outcome (log‐rank p = .901). Cox regression analysis revealed PET‐EF (HR 4.41, 95% CI: 1.72–11.36, p = .002) and moderate/severe mitral regurgitation (HR 2.32, 95% CI: 1.02–5.30, p = .046) as independent predictors of adverse cardiac outcome in patients with VT/VF. PI‐LVA patients with VT/VF are at high risk of adverse cardiac outcome, and coronary revascularization does not mitigate this risk, although revascularization was associated with higher cardiac survival in PI‐LVA patients without VT/VF.
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