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心梗急性期室顫對(duì)遠(yuǎn)期死亡率并無影響

2013-11-28 10:16 閱讀:3680 來源:醫(yī)學(xué)界 作者:孫福慶 責(zé)任編輯:云霄飄逸
[導(dǎo)讀] 法國(guó)一項(xiàng)研究表明,心梗急性期出現(xiàn)心室顫動(dòng)(以下簡(jiǎn)稱室顫)的患者院內(nèi)死亡風(fēng)險(xiǎn)升高,但室顫與遠(yuǎn)期全因或心源性死亡率升高并無相關(guān)性。論文11月19日在線發(fā)表于《歐洲心臟雜志》。

   

    心室顫動(dòng)是指心室發(fā)生無序的激動(dòng),致使心室規(guī)律有序的激動(dòng)和舒縮功能消失,其均為功能性的心臟停跳,是致死性心律失常。

    法國(guó)一項(xiàng)研究表明,心梗急性期出現(xiàn)心室顫動(dòng)(以下簡(jiǎn)稱室顫)的患者院內(nèi)死亡風(fēng)險(xiǎn)升高,但室顫與遠(yuǎn)期全因或心源性死亡率升高并無相關(guān)性。論文11月19日在線發(fā)表于《歐洲心臟雜志》。

    此項(xiàng)前瞻性隨訪隊(duì)列研究共納入3670例心梗住院患者。依據(jù)心梗急性期是否出現(xiàn)室顫,在出院存活患者中對(duì)院內(nèi)死亡率和5年死因加以評(píng)估。心梗急性期室顫患者為11例。94.5%的患者完成了5年隨訪。

    結(jié)果顯示,室顫患者的院內(nèi)死亡率顯著升高(校正OR 7.38;P<0.001)。在3463例出院存活者中,1024例在平均52 ± 2月隨訪期間死亡。5年總體生存率為74.4%.在Cox多變量分析中,心梗急性期并發(fā)室顫與5年死亡率升高無相關(guān)性(HR 0.78)。盡管心臟復(fù)律除顫器置入率極低(1.2%),但伴和不伴室顫患者的5年死因分布并無顯著差異,尤其是心源性猝死。

    原文閱讀:

    Abstract

    AIMS: Limited data are available on long-term prognosis or causes-of-death **ysis among survivors of acute myocardial infarction (MI) according to whether or not they developed ventricular fibrillation (VF) during the acute stage of MI.

    METHODS AND RESULTS: Among 3670 MI patients hospitalized in France in 2005 and enrolled in this prospective follow-up cohort study, we assessed in-hospital mortality and 5-year cause of death among those who survived to hospital discharge, according to whether they developed VF (116 cases) or not, during the acute stage. 94.5% of patients had complete follow-up at 5 years. In-hospital mortality was significantly higher among VF patients (adjusted OR 7.38, 95% CI 4.27-12.75, P < 0.001)。 Among 3463 survivors at hospital discharge, 1024 died during a mean follow-up of 52 ± 2 months. The overall survival rate at 5 years was 74.4% (95% CI 72.8-76.0)。 In Cox multivariate **ysis, occurrence of VF during the acute phase of MI was not associated with an increased mortality at 5 years (HR 0.78, 95% CI 0.38-1.58, P = 0.21)。 The distribution of causes of death at 5 years did not statistically differ according to the presence or absence of VF, especially for sudden cardiac death (13.1% in VF group vs.12.9% in non-VF group), despite a very low rate of implantation of cardioverter defibrillator in both groups (Overall rate 1.2%)。

    CONCLUSION: Patients developing VF in the setting of acute MI are at higher risk of in-hospital mortality. However, VF is not associated with a higher long-term all-cause or sudden cardiac death mortality.


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