| Part 1:The Predictors of In-hospital Death in Patients with Acute Myocardial Infarction and Malignent Ventricular ArrhythmiaObjective Analysis about the predictors of death in-hospital in those patients with acute myocardial infarction (AMI) suffered malignant ventricular arrhythmia (MVA). Methods Patients with acute myocardial infarction suffered malignant ventricular arrhythmia were divided into death group and survival group, from year 2002 to 2006. Results Totla 224 patients were recruited, male was dominant (77.2%), mean age was 60.2±12.1 years. Between the survival group and death group, some differences were observed incluing more male, younger, shorter period of AMI and MVA onset, better NYHA class better kidney function and lower K+concentration when suffered MVA in the survival group. Multivariate logistic analysis rvealed higher NYHA class (odds ratio 2.57,95%confidence interval 1.71-3.88, P<0.01), presence of J wave on a routine 12-lead electrocardiogram (odds ratio 2.5,95% confidence interval 1.08-5.8, P=0.03), higher K+concentration when suffered MVA (odds ratio 1.78,95%confidence interval 1.12-3.28, P=0.04), longer period of AMI and MVA onset (odds ratio 1.06,95%confidence interval 1.02-1.10, p<0.01), and higher Cr level (odds ratio 1.01,95%confidence interval 1.01-1.02, p<0.01) as predictors of death in-hospital. Conclusion In those patients suffered MVA in the period of AMI, higher NYHA class, J wave, higher K+concentration when suffered MVA, longer period of AMI and MVA onset and higher Cr level were associated with death in-hospital. Part 2:The Predictors of Motality and Sudden Cardiac Death in Patients with Acute Myocardial Infarction but without Serious Heart FailureObjective Analysis about the long term survival rate in those patients with acute myocardial infarction (AMI) and LVEF≥35%. Methods Patients with acute myocardial infarction suffered malignant ventricular arrhythmia and LVEF≥35%at 30 days after AMI were allocated to MVA group, from year 2002 to 2006. Recriuted patients with acute myocardial infarction (AMI) and LVEF≥35%but without MVA as NMVA group, from Jan to Jun in year 2006. The primary end point was all cause death and the secondary end point was MVA episodes. Results Totla 194 patients were recruited (MVA group n=81; NMVA group n=113), mean follow-up 32.62±10.19 months (5-1200 days). There were 42 all cause death (21.6%) and 29 MVA episodes (14.9%)happened in the whole period of follow-up. Compared the data of 2 groups, there were more death associated MVA happened in the MVA group than that in the NMVA group (14.8%vs.5.3%, p=0.03), and the trend of more MVA episodes (23.5%vs. 8.8%, p=0.07). Multivariate Cox regression analysis rvealed ST segment elevated myocardial infarction (harzard ratio 6.26,95%CI (1.18-33.24), p= 0.03), higher NYHA class (harzard ratio 4.48,95%CI (2.02-6.01), p<0.01), and older(harzard ratio 1.11,95%CI (1.05-1.15), p<0.01) predicted the high motality in the 3 years after AMI. And just presence of fragmented QRS on a routine 12-lead electrocardiogram (harzard ratio 3.36,95%CI (1.14-9.89), P=0.04) as predictors of MVA episodes recurrence in the 3 years. The group of MVA was analyzed along, the results showed presence of fragmented QRS on a routine 12-lead electrocardiogram (harzard ratio 1.94,95%CI (1.28-3.11), p=0.02), longer period of AMI and MVA onset (harzard ratio 5.78,95%CI (2.12-19.91), p=0.04), and higher NYHA class (harzard ratio 1.79,95%CI(1-3.19), p=0.04) as predictors of MVA episodes recurrence in the 3 years. Conclusion Whether the patients suffered MVA or not in the period of AMI, thier surcival rate was not different in the 3 years after AMI, but more MVA episodes will happen in the patients with MVA in the period of AMI. Presence of fragmented QRS on a routine 12-lead electrocardiogram means higher rate of MVA onset in the 3 years. The predictors of motality in the patients with AMI and LVEF≥35%were ST segment elevated myocardial infarction, higher NYHA class and older age. Objective To evaluate the safety and efficacy of long-time nifekalant hydrochloride (NIF) using in treatment of sustained ventricular tachyarrhythmia (S-VT). Methods Recruited patients with S-VT are separated to two groups, short-time group and long-time group. Results From September 2005 to November 2008,16 patients with S-VT were recruited in series, and separated to long-time group and short-time group according to different maintaining period (at least 1 hour and 12 hours, respectively) with o.8mg/kg/h after bolus dose (o.5mg/kg) injection. Second bolus dose after 90 minutes since the first dose can be used in long-time group. Better trend of LVEF is observed in long-time group compared with the short-time ((52.3±14.1)%vs. (39.1±15.4)%, P=0.054). Three patients were recovered to sinus rhythm within 60 minutes by continuous NIF using in each group. Four patients were recovered after 60 minutes in the long-time group. A significant prolonged QTc intervals was observed in the time of sinus rhythm recovered rather than 12 hours stopping of NIF, (543.1±67.4)ms vs. (490.9±51.8)ms, respectively (P<0.001). Electrocardiography analysis indicated QTd was significantly decreased 12 hours after stopping of infusing NIF compared with that when VT stopped ((45.4±22.1) ms vs. (73.4±33.2) ms, P<0.01), and the corrected QTd (QTcd) decreased too ((47.8±22.9) ms vs. (78.3±36.5) ms, P<0.01). There was a positive correlation between the increase in QTd and dose of administrating NIF (P<0.01), so was QTcd (P<0.01)No difference of QTc intervals were observed in two groups when sinus rhythm recovered (P=0.981). Just one patient occurred Tdp with a peak QTc of 610ms. No uncomfortable complaints or side-effects are recorded in other patients. Conclusion Acceptable safety and effectiveness are seen in long period using of NIF in the treatment of S-VT. More administration of NIF indicates higher terminating rate of VT and more QTd prolongation. However, the safety is acceptable if several important issues were noticed in using NIF, such as serum potassium concentration, stopping side-effect related agents, and carefully observing clinical responses.
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