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Frequency of nonsystem delays in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and implications for door-to-balloon time reporting (from the American Heart Association Mission: Lifeline program) Cardiac Troponin Composition Characterization after Non ST-Elevation Myocardial Infarction: Relation with Culprit Artery, Ischemic Time Window, and Severity of Injury Prognostic impact of atrial fibrillation in cardiogenic shock complicating acute myocardial infarction: a substudy of the IABP-SHOCK II trial Application of High-Sensitivity Troponin in Suspected Myocardial Infarction Fine particulate air pollution and hospital admissions and readmissions for acute myocardial infarction in 26 Chinese cities Quality of Care in Chinese Hospitals: Processes and Outcomes After ST-segment Elevation Myocardial Infarction Long-Term Coronary Functional Assessment of the Infarct-Related Artery Treated With Everolimus-Eluting Bioresorbable Scaffolds or Everolimus-Eluting Metallic Stents: Insights of the TROFI II Trial Antithrombotic Therapy in Patients With Atrial Fibrillation and Acute Coronary Syndrome Patterns of use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers among patients with acute myocardial infarction in China from 2001 to 2011: China PEACE-Retrospective AMI Study Comparison of the Preventive Efficacy of Rosuvastatin Versus Atorvastatin in Post-Contrast Acute Kidney Injury in Patients With ST-segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Original ResearchEpub January 12, 2018

JOURNAL:Am J Cardiol. Article Link

Prognostic Significance of Complex Ventricular Arrhythmias Complicating ST-Segment Elevation Myocardial Infarction

Tomasz Podolecki; Radoslaw Lenarczyk, Jacek Kowalczyk et al. Keywords: ventricular fibrillation, ventricular tachycardia, acute myocardial infarction, percutaneous coronary intervention

ABSTRACT


The aim of the study was to assess the clinical significance of complex ventricular arrhythmias (VAs) (sustained ventricular tachycardia (sVT) and ventricular fibrillation (VF)) in patients with ST-segment elevation myocardial infarction (STEMI) depending on timing of arrhythmia. We analyzed 4, 363 consecutive STEMI-patients treated invasively between 2004 and 2014. The median follow-up was 69.6 months (range: 0–139.8 months). The study population was divided into 2 main groups: VA Group encompassed 476 (10.91 %) patients with VAs, whereas 3887 (89.09 %) subjects without VT/VF were included into the Control Group. Among VA-population, pre-reperfusion VA (34.24%; n=163) was the most common arrhythmia, whereas reperfusion-induced, early post-reperfusion and late post-reperfusion VAs were diagnosed in: 103 (21.64 %), 103 (21.64 %) and 107 (22.48 %) patients, respectively. Every type of sVT/VF complicating STEMI portended significantly worse in-hospital prognosis, however a late onset arrhythmia was associated with the highest (over 5-fold) and reperfusion-induced VA with the lowest (less than 3-fold) increase in mortality risk compared to the Control Group. On the contrary, long-term mortality was significantly increased only in subjects with late post-reperfusion and pre-reperfusion VAs compared to VA-free population (43.93% and 36.81%, respectively vs. 22.58%; p<0.001). Apart from cardiogenic shock on admission, late post-reperfusion (HR 3.39) and pre-reperfusion VAs (HR 2.76) were the strongest independent predictors of death in the analyzed population. In conclusion, one in 10 patients with STEMI treated invasively was affected by sVT/VF. The clinical impact of VAs was strongly dependent on timing of arrhythmia.