急性ST段抬高型心肌梗死恶性室性心律失常发生率和预测因素的分析

摘要

Objective We hypothesized that primary percutaneous coronary intervention (PCI) and contemporary medical treatment will result in a lower incidence of malignant ventricular arrhythmias(VA). Methods We continuously monitored all patients with ST-segment elevation myocardial infarction(STEMI) for 48 hours. Results Of the 255 patients who underwent PCI for STEMI,12 (4.7%) developed malignant VA. Sixty percent of malignant VA occurred during the first 24 hours; and 92%,during the first 48 hours. After multivariate adjustment,independent predictors of sustained VA included total white blood cell count of 12 × 1012/L or more,hematocrit of 39%or less,and lack ofβ-blocker medication. Conclusions In this study,we could demonstrate that primary PCI results in a lower incidence of VA compared with data from the literature but did not shorten the time frame of VA occurrence.%目的：探讨急诊介入和当代药物治疗是否可降低急性ST段抬高型心肌梗死（STEMI）患者的恶性室性心律失常（VA）发生率。方法对2008年6月至2012年5月行急诊经皮冠状动脉介入（PCI）的急性STEMI患者均给予48h心电监护。结果255例行急诊PCI的患者有12例（4.7%）发生了恶性VA，其中60%的恶性VA发生于住院后的第1个24h，92%发生于住院后的第1个48h。多变量分析结果表明，恶性VA的独立预测因素包括白细胞计数升高、红细胞压积降低和未使用β-阻滞剂。结论急诊PCI可降低急性STEMI患者的恶性VA发生率，但不能缩短其发生的时间。