血运重建时代非选择性心肌梗死后患者QRS波群时间与晚期死亡率之间的关系

作     者：Bauer A. Watanabe M.A. Barthel P. G. Schmidt 王亭忠 

作者机构：Medizinische Klinik der Technischen Universitt München Deutsches Herzzentrum München Ismaninger Straβe 22 81675 Mü nchen Germany 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第6期

页      面：51-52页

学科分类：0831[工学-生物医学工程（可授工学、理学、医学学位）] 1002[医学-临床医学] 08[工学] 1010[医学-医学技术（可授医学、理学学位）] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：血运重建治疗 QRS波群 时间延长 总死亡率 非选择性 心肌梗死 患者 晚期 经皮冠状动脉介入 死后 

摘      要：Aims: To assess the association of prolonged QRS duration and late mortality in unselected post- infarction patients of the revascularization era. Methods and results: A total of 1455 survivors of acute myocardial infarction(MI) in sinus rhythm and under 76 years of age were enrolled. Ninety eight percent of the patients received reperfusion/ revascularization therapy(90% percutaneous coronary intervention). After revascularization, prolonged QRS duration(≥ 120 ms) was present in 87 patients(6.0% ). Additional risk factors studied were age(≥ 65 years), presence of diabetes mellitus, history of previous MI, mean heart rate(75 b.p.m.), heart rate variability index(≤ 20 U), arrhythmia on Holter, left ventricular ejection fraction(LVEF ≤ 30% ), and heart rate turbulence(HRT). Primary endpoint was total mortality. During a follow- up period of 22± 5 months, 70 patients died. On multivariable analysis, prolonged QRS duration showed the highest association with total mortality(hazard ratio 4.0; Cl 2.3- 6.9) followed by HRT Category 2(3.8; 2.0- 7.3) and LVEF≤ 30% (3.1; 1.7- 5.6). The association of prolonged QRS duration and late mortality was particularly strong in patients with LVEF ≤ 30% (5.0; 1.8- 14.1). On multivariable analysis of secondary endpoints, prolonged QRS duration was significantly associated with cardiac mortality(3.9; 1.9- 7.8), but not with sudden death and serious arrhythmic events. Conclusion: In the revascularization era, incidence of prolonged QRS duration is reduced. However, prolonged QRS duration is still highly correlated with increased late mortality.