昏迷和突发死亡的风险在高伤性心肌病症的突发死亡
Paolo Spirito1, Camillo Autore, Claudio Rapezzi
1Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Via Volta 8, Genova 16128, Italy. paolo.spirito@galliera.it
Circulation
|March 25, 2009
概括
过度缩性心肌病患者的不明原因昏迷是突然死亡的危险因素,尤其是在评估前发生时. 在老年患者中,远程昏迷并不会增加这种风险.
科学领域:
- 心脏病学 心脏病学
- 临床医学 临床医学
- 突然的心脏病死亡.
背景情况:
- 昏迷在高性心肌病 (HCM) 的预后意义尚未得到充分研究.
- 目前对昏迷的HCM治疗策略依赖于经验而不是证据.
研究的目的:
- 在大量HCM患者中调查昏迷和突然死亡之间的关系.
- 确定与HCM突发死亡风险增加相关的特定昏迷特征.
主要方法:
- 在1511名连续的HCM患者中评估了昏迷和突然死亡.
- 被归类为不明原因或神经介导的昏迷.
- 利用多变量分析来确定突然死亡的风险因素,重点关注昏迷的时间接近.
主要成果:
- 14%的患者出现了无法解释的昏迷;3.4%的患者出现了神经介导的昏迷.
- 莫名其妙的昏迷显示了增加突然死亡风险的趋势 (RR 1.78,P=0.08).
- 在评估后6个月内昏迷显著增加了突然死亡风险 (AHR 4.89),特别是在年轻患者中. 在老年患者中,远程昏迷并没有增加风险.
结论:
- 莫名其妙的昏迷是高性心肌病症突然死亡的重要危险因素.
- 与临床评估相比,无法解释的同步事件的时间对于风险分层至关重要.
- 患有远程昏迷发作的老年HCM患者不会面临突然死亡的风险增加.
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