未被指南涵盖的心肌梗死后猝死高风险人群的预测及管理

Prediction and Management of People at High Risk of Sudden Death after Myocardial Infarction Who are not Covered by Guidelines

目前关于心肌梗死后心脏性猝死的预防主要依赖于左心室射血分数,但是这一单一指标在区分真正的猝死高风险人群中存在不足。本文结合近年来出现的新的临床证据,讨论利用左心室射血分数对猝死风险进行分层存在的缺陷、心肌梗死后早期对猝死高风险人群进行干预、对射血分数降低的患者重新进行猝死危险分层、识别射血分数保留或轻度降低患者中的猝死高风险人群等问题,以及新型临床评分系统、心脏磁共振、无创心电学及侵入性电生理检查在猝死预测及管理中的作用,以期为心肌梗死患者的长期精准管理和风险预警提供参考。

The prevention of sudden cardiac death after myocardial infarction in contemporary clinical practice primarily relies on the evaluation of left ventricular ejection fraction(LVEF).However,the single measurement is inadequate to identify people who are truly at high risk of sudden cardiac death.Based on the new clinical evidence that has been emerged in recent years,this review discussed the limitations of risk stratification for sudden death by LVEF,the exploration of early intervention in patients with high risk of sudden death after myocardial infarction,the re-stratification of patients with reduced LVEF for selecting the candidates who would benefit the most from implantable cardioverter defibrillator treatment,and the identification of patients with high risk of sudden death in those with preserved or slightly depressed LVEF.Furthermore,the paper reviewed the role of novel clinical scoring systems,cardiac magnetic resonance,noninvasive electrocardiography,and invasive electrophysiological testing in the prediction and management of sudden death.This review is expected to provide references for the long-term precise management and risk warning of patients with myocardial infarction.