Prognostic factors affecting the all-cause death and sudden cardiac death rates of post myocardial infarction patients with low left ventricular ejection fraction  

作　　者：DAI Shi-mo ZHANG Shu CHEN Ke-ping HUA Wei WANG Fang-zheng CHEN Xin 

机构地区：[1]Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospitaland Cardiovascular Institute, Chinese Academy of MedicalSciences & Peking Union Medical College, Beijing 100037, China

出　　处：《Chinese Medical Journal》2009年第7期802-806,共5页中华医学杂志（英文版）

摘　　要：Background Post myocardial infarction （post-MI） patients with low left ventricular ejection fraction （LVEF） have been candidates for an implantable cardioverter-defibrillator （ICD） since the Multicenter Automatic Defibrillator Implantation Trail Ⅱ （MADIT Ⅱ）. However, due to the high costs of ICDs, widespread usage has not been accepted. Therefore, further risk stratification for post-MI patients with low LVEF may aid in the selection of patients that will benefit most from ICD treatment. Methods Four hundred and seventeen post-MI patients with low LVEF （≤35%） were enrolled in the study. All the patients received standard examination and proper treatment and were followed up to observe the all-cause death rate and sudden cardiac death （SCD） rate. Then COX proportional-hazards regression model was used to investigate the clinical factors which affect the all-cause death rate and SCD rate. Results Of 55 patients who died during （32±24） months of follow-up, 37 （67%） died suddenly. After adjusting for baseline clinical characteristics, multivariate COX proportional-hazards regression model identified the following variables associated with death from all causes： New York Heart Association （NYHA） heart failure class ≥Ⅲ （Hazard ratio： 2.361）, LVEF ≤20% （Hazard ratio： 2.514）, sustained ventricular tachycardia （Hazard ratio： 6.453）, and age 〉70 years （Hazard ratio： 3.116）. The presence of sustained ventricular tachycardia （Hazard ratio： 6.491） and age ≥70 years （Hazard ratio： 2.694） were specifically associated with SCD. Conclusions In the post-MI patients with low LVEF, factors as LVEF ≤20%, age ≥70 years, presence of ventricular tachycardia, and NYHA heart failure class ≥111 predict an adverse outcome. The presence of sustained ventricular tachycardia and age ≥70 years was associated with occurrence of SCD in these patients.Background Post myocardial infarction （post-MI） patients with low left ventricular ejection fraction （LVEF） have been candidates for an implantable cardioverter-defibrillator （ICD） since the Multicenter Automatic Defibrillator Implantation Trail Ⅱ （MADIT Ⅱ）. However, due to the high costs of ICDs, widespread usage has not been accepted. Therefore, further risk stratification for post-MI patients with low LVEF may aid in the selection of patients that will benefit most from ICD treatment. Methods Four hundred and seventeen post-MI patients with low LVEF （≤35%） were enrolled in the study. All the patients received standard examination and proper treatment and were followed up to observe the all-cause death rate and sudden cardiac death （SCD） rate. Then COX proportional-hazards regression model was used to investigate the clinical factors which affect the all-cause death rate and SCD rate. Results Of 55 patients who died during （32±24） months of follow-up, 37 （67%） died suddenly. After adjusting for baseline clinical characteristics, multivariate COX proportional-hazards regression model identified the following variables associated with death from all causes： New York Heart Association （NYHA） heart failure class ≥Ⅲ （Hazard ratio： 2.361）, LVEF ≤20% （Hazard ratio： 2.514）, sustained ventricular tachycardia （Hazard ratio： 6.453）, and age 〉70 years （Hazard ratio： 3.116）. The presence of sustained ventricular tachycardia （Hazard ratio： 6.491） and age ≥70 years （Hazard ratio： 2.694） were specifically associated with SCD. Conclusions In the post-MI patients with low LVEF, factors as LVEF ≤20%, age ≥70 years, presence of ventricular tachycardia, and NYHA heart failure class ≥111 predict an adverse outcome. The presence of sustained ventricular tachycardia and age ≥70 years was associated with occurrence of SCD in these patients.

关 键 词：myocardial infarction death  sudden  cardiac heart failure 

分 类 号：R542.22[医药卫生—心血管疾病] R473.5[医药卫生—内科学]