Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era
Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era
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DOI：
10.1253/circj.cj-16-0183
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发表时间：
2016-07-01
影响因子：
3.3
通讯作者：
Sakata, Yasushi
中科院分区：
文献类型：
--
作者：
Masuda, Masaharu;Nakatani, Daisaku;Sakata, Yasushi
背景资料：本研究的目的是探讨急性相室性心动过速和室颤（VT/VF）对ST段抬高型心肌梗死（STEMI）患者在经皮冠状动脉介入治疗（PCI）时代的预后影响。使用大坂急性冠状动脉功能不全研究（OACIS）的数据库，我们研究了4，283例在STEMI发作12小时内住院并接受紧急PCI的STEMI连续患者。急性期VT/VF，定义为住院第1周内≥ 3次连续室性早搏和/或VF，997例（23.3%）患者发生。急性期VT/VF患者的院内死亡风险显著高于无急性期VT/VF患者（14.6% vs.4.3%，校正风险比（HR）1.83，P=0.0013）。在存活出院的患者中，有和无急性期VT/VF的患者的5年死亡率相当。亚组分析显示，急性期VT/VF与高危患者出院后5年死亡率增加相关（GRACE风险评分>= 115;校正HR 1.60，P=0.043），但与中、低危患者无关。结论：即使在PCI时代，急性期VT/VF与STEMI患者较高的院内死亡率相关。然而，急性期VT/VF的5年预后影响仅限于高危患者。
Background: The aim of this study was to investigate the prognostic impact of acute-phase ventricular tachycardia and fibrillation (VT/VF) on ST-segment elevation myocardial infarction (STEMI) patients in the percutaneous coronary intervention (PCI) era.Methods and Results: Using the database of the Osaka Acute Coronary Insufficiency Study (OACIS), we studied 4,283 consecutive patients with STEMI who were hospitalized within 12 h of STEMI onset and underwent emergency PCI. Acute-phase VT/VF, defined as >= 3 consecutive ventricular premature complexes and/or VF within the 1st week of hospitalization, occurred in 997 (23.3%) patients. In-hospital mortality risk was significantly higher in patients with acute-phase VT/VF than inthose without (14.6% vs. 4.3%, adjusted hazard ratio (HR) 1.83, P=0.0013). Among patients discharged alive, 5-year mortality rates were comparable between patients with and without acute-phase VT/VF. Subgroup analysis showed that acute-phase VT/VF was associated with increased 5-year mortality after discharge in high-risk patients (GRACE Risk Score >= 115; adjusted HR 1.60, P=0.043), but not in intermediate-or low-risk patients.Conclusions: Even in the PCI era, acute-phase VT/VF was associated with higher in-hospital deaths of STEMI patients. However, the 5-year prognostic impact of acute-phase VT/VF was limited to high-risk patients.