CLASSIFICATION OF DEATHS AFTER MYOCARDIAL-INFARCTION AS ARRHYTHMIC OR NONARRHYTHMIC (THE CARDIAC-ARRHYTHMIA PILOT-STUDY)
CLASSIFICATION OF DEATHS AFTER MYOCARDIAL-INFARCTION AS ARRHYTHMIC OR NONARRHYTHMIC (THE CARDIAC-ARRHYTHMIA PILOT-STUDY)
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DOI：
10.1016/0002-9149(89)91065-5
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发表时间：
1989-01-01
影响因子：
2.8
通讯作者：
VERTER, J
中科院分区：
文献类型：
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作者：
GREENE, HL;RICHARDSON, DW;VERTER, J
心律失常初探性研究（CAPS）是一项在502例急性心肌梗死后6至60天至少有10次室性早搏/小时的患者中进行的抗心律失常药物（恩卡尼、氟卡尼、莫雷西嗪、丙咪嗪和安慰剂）的随机、双盲试验。CAPS测试了进行更大规模研究的可行性，以确定急性心肌梗死后抑制心室异位活动是否可以改善生存率。CAPS患者随访1年。所有死亡或心脏骤停事件均由至少2名研究者使用分类方案进行评价，该分类方案将潜在机制描述为心源性、心源性非心源性或非心源性。45例患者（9%）在1年随访期间死亡或发生心脏骤停，29例（64%）在症状发作1小时内死亡，16例> 1小时。23例死亡（51%）被归类为肺源性，19例（42%）为非肺源性，3例（7%）为非心源性。 急性心肌缺血或梗死与16例患者（36%）的死亡/心脏骤停事件相关，其中8例为猝死组。审查者之间的分类不一致在长期存在充血性心力衰竭症状的患者中尤其常见，这些患者通常难以确定死亡/心脏骤停事件中症状发作的确切时间。仅使用症状的时间关系对死亡或心脏骤停进行分类，45例患者中有12例（27%）的机制与基于事件委员会审查的分类不一致。将死亡分类为猝死或非猝死并不等同于将死亡分类为非猝死或非猝死。
The Cardiac Arrhythmia Pilot Study (CAPS) was a randomized, double-blind trial of antiarrhythmic drugs (encainide, flecainide, moricizine, imipramine and placebo) in 502 patients with at least 10 ventricular premature complexes/hour, 6 to 60 days after acute myocardial infarction. CAPS tested the feasibility of performing a larger study to determine if suppression of ventricular ectopic activity after acute myocardial infarction could improve survival. Patients in CAPS were followed for 1 year. All death or cardiac arrest events were evaluated by at least 2 investigators using a classification scheme that characterized the underyling mechanism as cardiac arrhythmic, cardiac nonarrhythmic or noncardiac. Forty-five patients (9%) died or had cardiac arrest during the 1-year follow-up, 29 (64%) within 1 hour from the onset of symptoms and 16 > 1 hour from the onset of symptoms. Twenty-three deaths (51%) were classified as arrhythmic, 19 (42%) as nonarrhythmic and 3 (7%) as noncardiac. Acute myocardial ischemia or infarction was associated with the death/cardiac arrest event in 16 patients (36%), 8 in the arrhythmic death group. Discrepancies in classification among reviewers were particularly common in patients with long-standing symptoms of congestive heart failure, in whom it was frequently difficult to identify the precise moment of the onset of symptoms in the death/cardiac arrest event. Using only the temporal relation of symptoms to categorize deaths or cardiac arrests, the mechanism of 12 (27%) of the 45 patients was in disagreement with the classification based on the Events Committee review. Classification of death as sudden or nonsudden is not equivalent to the classification of death as arrhythmic or nonarrhythmic.