摘要
背景:原发性室颤(VF)是心肌梗死急性期的主要死因。对具有原发性VF风险患者的识别尚待提高。方法和结果:进行此项病例对照研究以确定初发ST段抬高型心肌梗死(STEMI)患者发生原发性VF的独立危险因素。试验纳入330例原发性VF存活者(病例组)和372例对照者,排除早期梗死或有器质性心脏病征象的患者。
BACKGROUND -Primary ventricular fibrillation(VF) accounts for the majority of deaths during the acute phase of myocardial infarction. Identification of patients at risk for primary VF remains very poor. METHODS AND RESULTS -We performed a case-control study in patients with a first ST-elevation myocardial infarction(STEMI) to identify independent risk factors for primary VF. A total of 330 primary VF survivors(cases) and 372 controls were included; patients with earlier infarcts or signs of structural heart disease were excluded. Baseline characteristics, including age, gender, drug use, and ECG parameters registered well before the index infarction, as well as medical history, were not different. Infarct size and location, culprit coronary artery, and presence of multivessel disease were similar between groups. Analysis of ECGs performed at hospital admission for the index STEMI revealed that cumulative ST deviation was significantly higher among cases(OR per 10-mm ST deviation 1.59, 95%CI 1.25 to 2.02). Analysis of medical histories among parents and siblings showed that the prevalence of cardiovascular disease was similar between cases and controls(73.1%and 73.0%, respectively); however, familial sudden death occurred significantly more frequently among cases than controls(43.1%and 25.1%, respectively; OR 2.72, 95%CI 1.84 to 4.03). CONCLUSIONS -In a population of STEMI patients, the risk of primary VF is determined by cumulative ST deviation and family history of sudden death.
