PDF(Pubmed)
Abstract：
UNASSIGNED: Patients with acute myocardial infarction (AMI) complicated with arrhythmia are not uncommon. Insertion of temporary pacemakers (tPMs) in patients with arrythmia during acute myocardial infarction (AMI) is imperative support therapy. Arrhythmias include high-degree atrioventricular block (AVB), sinus arrest/bradycardia, and ventricular arrythmia storm. To date, no study has evaluated the prognosis of tPMs in patients with AMI complicated with arrhythmia. Especially in the era of thrombolysis or emergency percutaneous coronary intervention (PCI) for coronary artery revascularization, our study was designed to investigate the value of tPMs implantation in cases of AMI complicated with various arrhythmias.
UNASSIGNED: From January 2009 to January 2019, 35,394 patients with AMI, including 62.0% (21,935) with ST-segment elevation myocardial infarction (STEMI) and 38.0% (13,459) with non-ST-segment elevation myocardial infarction (NSTEMI) in four hospitals, were reviewed. A total of 552 patients with AMI associated with arrythmia were included in the cohort. Among the 552 patients, there were 139 patients with tPM insertions. The incidence trend of myocardial infarction complicated with various arrhythmias in the past 10 years was analysed, and the clinical characteristics, in-hospital mortality, postdischarge mortality, composite endpoints of modality, and independent risk factors were compared in patients with and without tPM in the era of coronary artery revascularization.
UNASSIGNED: In patients with AMI-associated arrythmia, high-degree AVB was the major cause of tPM insertion (p = 0.045). In the past 10 years, the number of patients with high-degree AVB, tPM implantation, ventricular arrythmia storm, and in-hospital mortality has decreased year by year in the era of coronary artery revascularization. In the tPM group, the culprit vessel was the left main artery, and cardiogenic shock, acute renal injury and high brain natriuretic peptide (BNP) levels were independent risk factors for patients with AMI complicated with arrhythmia. The in-hospital mortality in the tPM group was higher than that in the non-tPM group. The patients with tPM insertion showed better postdischarge survival than patients without tPM insertion.
UNASSIGNED: In the era of emergency thrombolysis or PCI, coronary revascularization can ameliorate the prognosis of patients with AMI complicated with various arrhythmias. Temporary pacemaker insertion in patients with AMI complicated with arrhythmia can reduce the postdischarge mortality of these patients.
UNASSIGNED: From January 2009 to January 2019, 35,394 patients with AMI, including 62.0% (21,935) with ST-segment elevation myocardial infarction (STEMI) and 38.0% (13,459) with non-ST-segment elevation myocardial infarction (NSTEMI) in four hospitals, were reviewed. A total of 552 patients with AMI associated with arrythmia were included in the cohort. Among the 552 patients, there were 139 patients with tPM insertions. The incidence trend of myocardial infarction complicated with various arrhythmias in the past 10 years was analysed, and the clinical characteristics, in-hospital mortality, postdischarge mortality, composite endpoints of modality, and independent risk factors were compared in patients with and without tPM in the era of coronary artery revascularization.
UNASSIGNED: In patients with AMI-associated arrythmia, high-degree AVB was the major cause of tPM insertion (p = 0.045). In the past 10 years, the number of patients with high-degree AVB, tPM implantation, ventricular arrythmia storm, and in-hospital mortality has decreased year by year in the era of coronary artery revascularization. In the tPM group, the culprit vessel was the left main artery, and cardiogenic shock, acute renal injury and high brain natriuretic peptide (BNP) levels were independent risk factors for patients with AMI complicated with arrhythmia. The in-hospital mortality in the tPM group was higher than that in the non-tPM group. The patients with tPM insertion showed better postdischarge survival than patients without tPM insertion.
UNASSIGNED: In the era of emergency thrombolysis or PCI, coronary revascularization can ameliorate the prognosis of patients with AMI complicated with various arrhythmias. Temporary pacemaker insertion in patients with AMI complicated with arrhythmia can reduce the postdischarge mortality of these patients.
摘要：
■急性心肌梗死（AMI）并发心律失常的患者并不少见。在急性心肌梗死（AMI）期间心律失常患者中插入临时起搏器（tPM）是必要的支持治疗。心律失常包括高度房室传导阻滞（AVB），窦性停搏/心动过缓,室性心律失常风暴。迄今为止,尚无研究评估AMI并发心律失常患者tPMs的预后。特别是在溶栓或急诊经皮冠状动脉介入治疗（PCI）冠状动脉血运重建的时代，本研究旨在探讨在AMI并发各种心律失常病例中植入tPMs的价值。
■从2009年1月到2019年1月，35,394例AMI患者，包括4家医院的62.0%(21,935)的ST段抬高型心肌梗死(STEMI)和38.0%(13,459)的非ST段抬高型心肌梗死(NSTEMI),被审查了。共有552名AMI患者与心律失常相关。在552名患者中，有139例患者进行了tPM插入。分析近10年心肌梗死并发各种心律失常的发病趋势,和临床特征，住院死亡率，出院后死亡率,模态的复合端点，在冠状动脉血运重建时代，比较有和无tPM的患者的独立危险因素。
■在AMI相关心律失常患者中，高度AVB是tPM插入的主要原因(p=0.045)。在过去的10年里,高度AVB患者的数量，tPM植入,室性心律失常风暴，在冠状动脉血运重建时代，院内死亡率逐年下降。在tPM组中，罪魁祸首血管是左主动脉,和心源性休克,急性肾损伤和高脑钠肽(BNP)水平是AMI并发心律失常的独立危险因素。tPM组的住院死亡率高于非tPM组。与未插入tPM的患者相比，插入tPM的患者显示出更好的出院后生存率。
■在急诊溶栓或PCI时代，冠状动脉血运重建可以改善AMI并发各种心律失常患者的预后。AMI合并心律失常患者临时置入起搏器可降低出院后病死率。
■从2009年1月到2019年1月，35,394例AMI患者，包括4家医院的62.0%(21,935)的ST段抬高型心肌梗死(STEMI)和38.0%(13,459)的非ST段抬高型心肌梗死(NSTEMI),被审查了。共有552名AMI患者与心律失常相关。在552名患者中，有139例患者进行了tPM插入。分析近10年心肌梗死并发各种心律失常的发病趋势,和临床特征，住院死亡率，出院后死亡率,模态的复合端点，在冠状动脉血运重建时代，比较有和无tPM的患者的独立危险因素。
■在AMI相关心律失常患者中，高度AVB是tPM插入的主要原因(p=0.045)。在过去的10年里,高度AVB患者的数量，tPM植入,室性心律失常风暴，在冠状动脉血运重建时代，院内死亡率逐年下降。在tPM组中，罪魁祸首血管是左主动脉,和心源性休克,急性肾损伤和高脑钠肽(BNP)水平是AMI并发心律失常的独立危险因素。tPM组的住院死亡率高于非tPM组。与未插入tPM的患者相比，插入tPM的患者显示出更好的出院后生存率。
■在急诊溶栓或PCI时代，冠状动脉血运重建可以改善AMI并发各种心律失常患者的预后。AMI合并心律失常患者临时置入起搏器可降低出院后病死率。
