心室晚电位预测急性心肌梗死预后10年回顾

目的探讨心室晚电位(LP)对急性心肌梗死(AMI)患者病死率的预测价值。方法对1997年12月至1999年12月因AMI入院连续243例患者的临床资料进行回顾性总结。收集患者的临床特征、梗死血管开通情况、无创心脏检查结果和预后资料等进行统计分析。结果 243例患者男180例(74.1%),年龄37～79岁,平均(62±11.4)岁,接受血运重建治疗的患者146例(60%)。分成LP阳性83例(34%)和LP阴性160例(66%)两组。主要联合终点事件为严重心律失常、心源性猝死和心力衰竭死亡,次要联合终点事件为联合严重心律失常和心源性猝死.在平均随访(10±0.83)年期间,LP阳性与LP刚性两组比较主要终点事件累计发生率[18.1%比11.9%,相对风险比(HR)4.19,95%可信区间(CI)2.50～7.02,P<0.0001]和次要终点事件累计发生率(7.0%比2.1%,HR7.64,95% CI2.02～20.75,P<0.0001)均明显增高;Kaplan-Meier生存曲线分析,无主要终点事件累计生存率LP阳性较LP阴性组明显减低,分别为47.0%和81.9%(P<0.0001)。LP阳性组的生存曲线随时间延续呈明显下降趋势(P<0.0001)。Cox风险比例回归模型多因素分析,评判影响主要终点事件的各因素预测能力,LP阳性的风险度明显强于其他已知风险预测变量,其相对危险性依次为LP阳性(HR 3.57,95% CI 1.87～6.81,P<0.0001)、复杂室性心律失常(HR 2.75,95% CI 1.32～5.71,P=0.007)、左心室射血分数<40%(HR 2.44,95%CI1.25～5.71,P=0.009)、未开通梗死血管(HR 1.95,95% CI 1.05～3.59,P=0.033)、年龄(HR 1.04,95% CI 1.00～1.07,P=0.034)。结论 LP阳性是AMI后不良事件和死亡的独立预测指标。

A retrospective study On long-term prognostic significance of ventricular late potentials after acute myocardial infarction

Objective To explore the prognostic value of ventricular late potentials (LP) in post-infarction patients.Methods A total of 243 consecutive survivors of acute myocardial infarction(AMI) from Dec.1997 to Dec.1999 in our hospital were reviewed and eligible patients were divided into LP positive group (n=83) and LP negative group(n= 60).The mean follow up time was (10±0.83)years.The primary endpoints were composite of serious arrhythmic events,sudden cardiac death and congestive heart failure death.The secondary endpoints were composite of serious arrhythmic events and sudden cardiac death.Results The incidences of primary endpoints and secondary endpoints were significantly higher in LP positive group than in LP negative group(18.1% vs.11.9%,HR 4.19,95% CI 2.50-7.02,P<0.0001 and 7.0% vs.2.1%,HR 7.64,95% CI 2.02-20.75,P<0.0001).Kaplan-Meier survival analysis showed that the survival rate of free of events in LP positive group was significantly lower than that in LP negative group (47.0% vs.81.9% P<0.0001).Muhivariate Cox regression analysis showed that LP positive was the strongest independent predictor of the primary endpoints(HR 3.57,95% CI 1.87-6.81,P<0.0001).Conclusions LP positive is a powerful predictor of poor prognosis in patients with myocardial infarction.