Relation of T-Wave Alternans to Mortality and Nonsustained Ventricular Tachycardia in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome from the MERLIN-TIMI 36 Trial of Ranolazine Versus Placebo

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• 作者：Tuomo Nieminen ; MD ; PhD^a ; ^b ; ^c ; Benjamin M. Scirica ; MD ; MPH^c ; ^d ; Jose R.M. Pegler ; BS^b ; ^e ; Caio Tavares ; BS^b ; ^e ; Vitor P.F. Pagotto ; BS^b ; ^e ; Alexandre F. Kanas ; BS^b ; ^e ; Marcel F. Sobrado ; BS^b ; ^e ; Bruce D. Nearing ; PhD^b ; ^c ; Amarachi A. Umez-Eronini ; MS^d ; David A. Morrow ; MD ; MPH^c ; ^d ; Luiz Belardinelli ; MD^f ; Richard L. Verrier ; PhD^b ; ^c ; ^{rverrier@bidmc.harvard.edu" class="auth_mail}
• 刊名：The American Journal of Cardiology
• 出版年：1 July 2014
• 年：2014
• 卷：114
• 期：1
• 页码：17-23
• 全文大小：418 K

文摘

We explored the utility of T-wave alternans (TWA) in predicting mortality in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS). Maximum TWA was calculated using Modified Moving Average method from continuous electrocardiographic recordings in patients with left ventricular ejection fraction <40% and ventricular tachycardia (VT) ≥4 beats during index hospitalization or sudden cardiac death during the follow-up year and age- and sex-matched controls in the Metabolic Efficiency with Ranolazine for Less Ischemia in Non–ST Elevation Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction (MERLIN-TIMI) 36 trial. All patients received standard therapy for NSTEACS plus ranolazine (n = 109) or placebo (n = 101). Median follow-up was 1 year. Baseline clinical characteristics did not differ between patients with elevated TWA (≥47 渭V) compared with lower levels. Patients with TWA ≥47 渭V at admission had increased risk of total mortality (adjusted odds ratio [OR_adj] 2.35, p = 0.04) during follow-up and VT ≥4 beats (OR_adj 2.70, p = 0.01) during hospitalization with a trend toward increased cardiovascular death risk (OR_adj 2.18, p = 0.07) during follow-up. In patients receiving placebo, TWA ≥47 渭V on day 6 was associated with increased risk of total mortality (OR 4.12, 95% confidence interval 1.25 to 13.64, p = 0.02) and cardiovascular death (OR 4.73, p = 0.01) during follow-up. No deaths occurred among patients with TWA ≥47 渭V assigned to ranolazine. In conclusion, in patients with NSTEACS and left ventricular ejection fraction <40%, TWA ≥47 渭V early after admission is associated with increased risk of mortality at 1 year and with nonsustained VT during hospitalization. TWA may be useful in risk estimation in patients with NSTEACS. The possibility that TWA may serve as a therapeutic target deserves further exploration.