心室颤动是指心室发生无序的激动,致使心室规律有序的激动和舒缩功能消失,其均为功能性的心脏停跳,是致死性心律失常。
法国一项研究表明,心梗急性期出现心室颤动(以下简称室颤)的患者院内死亡风险升高,但室颤与远期全因或心源性死亡率升高并无相关性。论文11月19日在线发表于《欧洲心脏杂志》。
此项前瞻性随访队列研究共纳入3670例心梗住院患者。依据心梗急性期是否出现室颤,在出院存活患者中对院内死亡率和5年死因加以评估。心梗急性期室颤患者为11例。94.5%的患者完成了5年随访。
结果显示,室颤患者的院内死亡率显著升高(校正OR 7.38;P<0.001)。在3463例出院存活者中,1024例在平均52 ±
2月随访期间死亡。5年总体生存率为74.4%.在Cox多变量分析中,心梗急性期并发室颤与5年死亡率升高无相关性(HR
0.78)。尽管心脏复律除颤器置入率极低(1.2%),但伴和不伴室颤患者的5年死因分布并无显著差异,尤其是心源性猝死。
原文阅读:
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.