Relation Between Myocardial Infarct Size and Ventricular Tachyarrhythmia Among Patients With Preserved Left Ventricular Ejection Fraction Following Fibrinolytic Therapy for ST-Segment Elevation Myocardial Infarction
Relation Between Myocardial Infarct Size and Ventricular Tachyarrhythmia Among Patients With Preserved Left Ventricular Ejection Fraction Following Fibrinolytic Therapy for ST-Segment Elevation Myocardial Infarction
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DOI：
10.1016/j.amjcard.2009.04.005
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发表时间：
2009-08-15
影响因子：
2.8
通讯作者：
Gibson, C. Michael
中科院分区：
文献类型：
--
作者：
Pride, Yuri B.;Appelbaum, Evan;Gibson, C. Michael
在ST段抬高心肌梗死早期再灌注治疗的时代，左心功能的保留是很常见的。尽管保留了左心室射血分数(LVEF)，但仍存在一系列不良心血管事件的风险，包括室性心动过速(VT)和室颤(VF)。在心肌梗死后人群中，较大的心肌梗死面积与死亡、室速/室颤和心力衰竭独立相关。据推测，在ST段抬高心肌梗死后左心功能正常的患者中，根据血清肌酸激酶(CK)-MB峰值浓度估计的心肌梗死范围与VT/VF的发生率有关。氯吡格雷作为辅助再灌注疗法-心肌梗死溶栓治疗28(Clarity-TIMI 28)研究纳入了3491名接受纤溶治疗的ST段抬高心肌梗死患者。评估估计的心肌梗死范围(CK-MB峰值与正常上限的比率)、左心室射血分数(用左心室造影术或超声心动图测量)和30天内室速/室颤发生率之间的关系。共有1,436名患者接受了左心功能评估，其中1,133名患者有足够的CK-MB用于分析。这组患者的平均左心室射血分数为55%(四分位数范围为45%到65%)，大多数患者(n=814[87.1%])的左心室射血分数(LVEF)和左心室射血分数(Gt；)=40%。在LVEF和GT；=40%的患者中，CK-MB峰值与正常上限的比值与30天内室速/室颤的发生率(趋势分别为2.2%、3.7%和5.5%，趋势P=0.041)和心血管死亡、心力衰竭、休克和室速/室颤的综合发生率(趋势分别为3.7%、6.0%和8.5%，趋势P=0.018)显著相关。综上所述，ST段抬高心肌梗死患者在再灌注治疗后左心功能未受影响，根据血清CK-MB峰值浓度估计，较大的心肌梗死范围与VT/VF及其他不良临床结局显著相关。(C)2009 Elsevier Inc.保留所有权利。(美国心脏杂志2009；104：475-479)
In the era of early reperfusion therapy for ST-segment elevation myocardial infarction, preserved left ventricular (LV) function is common. Despite preservation of LV ejection fraction (LVEF), there remains a spectrum of risk for adverse cardiovascular events, including ventricular tachycardia (VT) and ventricular fibrillation (VF). Larger infarct size has been independently associated with death, VT/VF, and heart failure in the post-myocardial infarction population. It was hypothesized that infarct size, as estimated by peak serum creatine kinase (CK)-MB concentration, would be associated with the incidence of VT/VF in patients with preserved LV function after ST-segment elevation myocardial infarctions. The Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis In Myocardial Infarction 28 (CLARITY-TIMI 28) study enrolled 3,491 patients with ST-segment elevation myocardial infarctions who underwent fibrinolytic therapy. The association between estimated infarct size (ratio of peak CK-MB to the upper limit of normal), the LVEF (measured using left ventriculography or echocardiography), and the incidence of VT/VF through 30 days was assessed. A total of 1,436 patients underwent assessments of LV function, of whom 1,133 had adequate CK-MB for analysis. The median LVEF in this group was 55% (interquartile range 45% to 65%), and most patients (n = 814 [87.1%]) had LVEF >= 40%. Among patients with LVEF >= 40%, the ratio of peak CK-MB to the upper limit of normal was significantly associated with the incidence of VT/VF through 30 days (2.2%, 3.7%, and 5.5% across tertiles, respectively, p = 0.041 for trend) and the incidence of the composite of cardiovascular death, heart failure, shock, and VT/VF through 30 days (3.7%, 6.0%, 8.5%, respectively, p = 0.018 for trend). In conclusion, in patients with ST-segment elevation myocardial infarction with preserved LV function after reperfusion therapy, larger infarct size, as estimated by peak serum CK-MB concentration, is significantly associated with VT/VF as well as other adverse clinical outcomes. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;104:475-479)