Sudden cardiac death after early-onset myocardial infarction: a multicentre longitudinal cohort study with a 20-year follow-up.

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-10-28 DOI:10.1093/ehjacc/zuae089
Serena Bricoli, Giulia Magnani, Maddalena Ardissino, Giuseppe Maglietta, Patrizia Celli, Maurizio Ferrario, Umberto Canosi, Carlo Cernetti, Francesco Negri, Piera Angelica Merlini, Marco Tubaro, Carlo Berzuini, Chiara Manzalini, Luigi Moschini, Elisabetta Ponte, Roberto Pozzi, Silvia Buratti, Andrea Botti, Federico Barocelli, Andrea Biagi, Rosario Bonura, Luca Bearzot, Tiziano Moccetti, Antonio Crocamo, Maria Francesca Notarangelo, Elisabetta Moscarella, Paolo Calabrò, Giampaolo Niccoli, Diego Ardissino
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引用次数: 0

Abstract

Aims: Sudden cardiac death (SCD) is a serious consequence of a myocardial infarction (MI), but identifying patients at risk of developing SCD remains a major clinical challenge, especially in the case of juvenile MI. The aim of this study is to identify predictors of SCD after early-onset MI using long-term follow-up data relating to a large nationwide patient cohort.

Methods and results: The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, who were followed up for a median of 19.9 years. Fine-Gray proportional hazard models were used to assess the associations between their clinical, demographic, and index event data and the occurrence of SCD. Sudden cardiac death occurred in 195 patients, who were more frequently males, were hypertensive and/or diabetic, had a history of previous thrombo-embolic events with a greater atherosclerotic burden, and had a lower left ventricular ejection fraction (LVEF) after the index event. A multivariable analysis showed that the independent predictors of SCD were diabetes, hypertension, previous thrombo-embolic events, a higher SYNTAX score, and a lower LVEF. There was no clear evidence of the clustering of SCD events during the follow-up. Sudden cardiac death was the first post-MI clinical event in 101 patients; the remaining 94 experienced SCD after a non-fatal MI or hospitalization for coronary revascularization.

Conclusion: Sudden cardiac death frequently occurs during the 20 years after early-onset MI. The nature of the identified predictors and the absence of clustering suggest that the pathophysiological basis of SCD may be related to progressive coronary atherosclerosis.

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早发心肌梗死后的心脏性猝死。一项为期 20 年的多中心纵向队列研究。
背景:心脏性猝死(SCD)是心肌梗死(MI)的一个严重后果,但识别有发生 SCD 风险的患者仍是一项重大的临床挑战,尤其是在幼年心肌梗死的情况下。本研究的目的是利用全国范围内大型患者队列的长期随访数据,确定早发心肌梗死后 SCD 的预测因素:方法:意大利早发心肌梗死遗传学研究招募了 2,000 名在 45 岁之前首次发生心肌梗死的患者,对他们进行了中位数为 19.9 年的随访。研究采用细格雷比例危险模型评估了这些患者的临床、人口统计学和指数事件数据与 SCD 发生之间的关联:结果:195名患者发生了SCD,他们多为男性、高血压和/或糖尿病患者;既往有血栓栓塞事件史,动脉粥样硬化负担较重;指数事件后左心室射血分数(LVEF)较低。多变量分析表明,糖尿病、高血压、既往血栓栓塞事件、较高的 Syntax 评分和较低的 LVEF 是 SCD 的独立预测因素。在随访过程中,没有明显证据表明SCD事件具有聚集性。101名患者在心肌梗死后首次发生SCD;其余94名患者在发生非致命性心肌梗死或因冠状动脉血运重建住院后发生SCD:结论:在早发心肌梗死后的 20 年中,SCD 频繁发生。结论:在早发心肌梗死后的 20 年中,SCD 频繁发生。已确定的预测因素的性质和无聚集现象表明,SCD 的病理生理学基础可能与进行性冠状动脉粥样硬化有关。
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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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