Relationship Between Nonsustained Ventricular Tachycardia After Non-ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death Observations From the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) Randomized Controlled Trial
Relationship Between Nonsustained Ventricular Tachycardia After Non-ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death Observations From the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) Randomized Controlled Trial
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DOI：
10.1161/circulationaha.110.937136
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发表时间：
2010-08-03
期刊：
影响因子：
37.8
通讯作者：
Morrow, David A.
中科院分区：
文献类型：
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作者：
Scirica, Benjamin M.;Braunwald, Eugene;Morrow, David A.
背景：大多数关于急性冠状动脉综合征后室性心动过速（VT）与心源性猝死（SCD）之间关系的研究都是在广泛应用再灌注、血运重建术或当代医学治疗之前进行的，并且仅限于st段抬高型心肌梗死。在接受当代治疗的非st段抬高急性冠状动脉综合征患者中，VT的发生率和预后意义尚未得到研究。方法与结果：雷诺嗪对非st段抬高急性冠状动脉综合征患者减少缺血的代谢效率-心肌梗死溶栓36 （MERLIN-TIMI 36）试验将6560例非st段抬高急性冠状动脉综合征住院患者随机分为雷诺嗪组和安慰剂组。在随机分组后的前7天进行连续心电图记录，并在盲法核心实验室进行评估。SCD （n = 121）在中位随访1年期间进行评估。共有6345例（97%）患者有可用于分析的连续心电图记录。与没有VT的患者（n = 2764）相比，只有心室三胞胎的患者发生SCD的风险没有增加（n = 1978, 31.2%）（1.4%对1.2%）；然而，室性心动过速持续4 - 7次的患者（n = 1172, 18.5%）（室性心动过速为2.9%，校正风险比为2.3,P < 0.001）和室性心动过速持续8次以上的患者（n = 431, 6.8%）（室性心动过速为4.3%，校正风险比为2.8,P = 0.001）发生SCD的风险显著增加。这种影响与基线特征和射血分数无关。入院后48小时内发生的室速与SCD无关。结论：非st段抬高急性冠状动脉综合征患者入院后，非持续性VT很常见，即使是持续4 - 7次的短暂VT发作也与随后一年发生SCD的风险独立相关。
Background-Most studies examining the relationship between ventricular tachycardia (VT) after acute coronary syndrome and sudden cardiac death (SCD) were performed before widespread use of reperfusion, revascularization, or contemporary medical therapy and were limited to ST-elevation myocardial infarction. The incidence and prognostic implications of VT in patients with non-ST-elevation acute coronary syndrome receiving contemporary care have not been examined.Methods and Results-The Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) trial randomized 6560 patients hospitalized with a non-ST-elevation acute coronary syndrome to ranolazine or placebo in addition to standard therapy. Continuous ECG recording was performed for the first 7 days after randomization and evaluated in a blinded core laboratory. SCD (n = 121) was assessed over a median follow-up of 1 year. A total of 6345 patients (97%) had continuous ECG recordings evaluable for analysis. Compared with patients with no VT (n = 2764), there was no increased risk of SCD in patients with only ventricular triplets (n = 1978, 31.2%) (1.4% versus 1.2%); however, the risk of SCD was significantly greater in patients with VT lasting 4 to 7 beats (n = 1172, 18.5%) (SCD, 2.9%; adjusted hazard ratio, 2.3; P < 0.001) and in patients with VT lasting at least 8 beats (n = 431, 6.8%) (SCD, 4.3%; adjusted hazard ratio, 2.8; P = 0.001). This effect was independent of baseline characteristics and ejection fraction. VT occurring within the first 48 hours after admission was not associated with SCD.Conclusion-Nonsustained VT is common after admission for non-ST-elevation acute coronary syndrome, and even short episodes of VT lasting 4 to 7 beats are independently associated with the risk of SCD over the subsequent year.