心梗后早期左心室功能障碍中室性心律失常的预后价值：法国全国性 WICD-MI 研究。

IF 37.6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal Pub Date : 2024-09-20 DOI:10.1093/eurheartj/ehae575

Mathieu Echivard,Jean-Marc Sellal,Chloé Ziliox,Eloi Marijon,Pierre Bordachar,Sylvain Ploux,Karim Benali,Christelle Marquié,Clémence Docq,Didier Klug,Romain Eschalier,Baptiste Maille,Jean-Claude Deharo,Dominique Babuty,Thibaud Genet,Estelle Gandjbakhch,Antoine Da Costa,Olivier Piot,Damien Minois,Jean-Baptiste Gourraud,Pierre Mondoly,Philippe Maury,Serge Boveda,Jean-Luc Pasquié,Raphaël Martins,Christophe Leclercq,Charles Guenancia,Gabriel Laurent,Mathieu Becker,Julien Bertrand,Philippe Chevalier,Vladimir Manenti,Maciej Kubala,Pascal Defaye,Peggy Jacon,Antoine Desbiolles,Marc Badoz,Laurence Jesel,Nicolas Lellouche,Paul-Ursmar Milliez,Paul Ollitrault,Samir Fareh,Matthieu Bercker,Jacques Mansourati,Benoît Guy-Moyat,Jean-Pierre Chabert,Nicolas Luconi,Pierre-François Winum,Frédéric Anselme,Fabrice Extramiana,Camille Delahaye,François Jourda,Olivier Bizeau,Mathieu Nasarre,Arnaud Olivier,Stéphane Fromentin,Thibault Villemin,Olivier Levavasseur,Néfissa Hammache,Isabelle Magnin-Poull,Hugues Blangy,Nicolas Sadoul,Kevin Duarte,Nicolas Girerd,Christian de Chillou

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引用次数: 0

摘要

背景和目的在急性心肌梗塞后 40 至 90 天重新评估左心室射血分数（LVEF）之前，不建议使用预防性植入式心律转复除颤器（ICD）。在当前的治疗时代，尚未对 LVEF 受损的心肌梗死后患者在梗死后早期（即出院后 3 个月内）发生的持续性室性心律失常（VAs）的预后进行专门评估。方法数据分析基于一项全国性登记，登记对象为急性心肌梗死后 LVEF ≤ 35% 的 1032 名连续患者，这些患者在指数心肌梗死后出院时被处方使用可穿戴式心律转复除颤器（WCD）3 个月后植入了 ICD。结果植入ICD的原因要么是在使用WCD期间出现了持续的VA（VA+/WCD，n = 72），要么是在梗死后早期阶段结束时LVEF仍≤35%（VA-/WCD，n = 960）。中位随访时间为 30.9 个月。在 ICD 植入后 1 年内，VA+/WCD 和 VA-/WCD 患者中分别有 22.2% 和 3.5% 出现持续 VA（P < .0001）。调整后的多变量分析显示，使用 WCD 时的持续 VA 可独立预测 1 年后持续 VA 的复发（调整后的危险比 [HR] 6.91；95% 置信区间 [CI] 3.73-12.81；P < .0001）和随访结束时的持续 VA 复发（调整后的 HR 3.结论在 LVEF ≤ 35% 的患者中，梗死后早期的持续 VA 可预测复发性持续 VA 和 1 年死亡率。

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Prognostic value of ventricular arrhythmia in early post-infarction left ventricular dysfunction: the French nationwide WICD-MI study.

BACKGROUND AND AIMS Prophylactic implantable cardioverter-defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study. METHODS Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF ≤ 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter-defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction. RESULTS ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained ≤35% at the end of the early post-infarction phase (VA-/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA-/WCD patients, respectively (P < .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73-12.81; P < .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37-6.30; P < .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28-6.39; P = .012). CONCLUSIONS In patients with LVEF ≤ 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality.

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来源期刊

European Heart Journal 医学-心血管系统

CiteScore

39.30

自引率

6.90%

发文量

3942

审稿时长

1 months

期刊介绍： The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters. In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.