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Long Term Prognosis of Ventricular
Arrhythmias in ST-Elevation
Myocardial Infarction Patients
Undergoing Percutaneous Coronary
Intervention
Guy Topaz, M.D., Sami Viskin, M.D.,
Yacov Shacham, M.D., and Arie Steinvil M.D. Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Israel
Introduction
• Incidence of arrhythmias and conduction disturbances after acute myocardial infarction (1).
• VA occur mostly during the first 48 hours (2).
(1) Bloch Thomsen PE, Circulation
2010
28%
13%
10%
7% 5%
3% 3%
0%
5%
10%
15%
20%
25%
30%
new-onset AF non-sustainedVT
high-degree AVB sinusbradycardia
sinus arrest sustained VT VF
Arrhythmias and conduction disturbances
(2) Henkel DM, Am Heart J. 2006
Introduction PVF is associated with increased in-hospital
mortality.
Mehta , JAMA 2009
22%
5%
0%
5%
10%
15%
20%
25%
VF/VT no VF/VT
30-day mortality - GUSTO trial
23.2%
3.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
VF/VT no VF/VT
90-day mortality - Mehta, JAMA
Askari, Am Heart J. 2009
Objective:
Evaluation of the long-term prognosis of PVF and
sustaines VT in STEMI patients undergoing primary
percutaneous coronary intervention (PCI).
Methods:
• A retrospective analysis included 1367 consecutive patients hospitalized with STEMI during 2008-2013.
• PVF was defined as VF occurring within 48 hours after STEMI in patients with no heart failure or cardiogenic shock.
• SVT was defined as VT lasting longer than 30 seconds in patients with no heart failure or cardiogenic shock.
Methods:
• VT/VF-Group was compared with a Control Group with STEMI but no VT/VF.
• Gender, age, diabetes, left ventricular ejection fraction and anterior STEMI were used as matching criteria.
• Patient’s characteristics were obtained from the computerized medical file.
Methods:
Primary and secondary outcome measures:
• Primary outcome was defined as all-cause mortality during follow up.
• Secondary outcome was defined as re-occurrence of ventricular arrhythmias and re-admission due to re-infarction.
Results: • Of 1367 STEMI patients: 69 (5%) had PVF or SVT.
• Control Group consisting of 138 patients with STEMI but no VT/VF.
VF/VT No VF/VT p value
Gender (male) 58 (84.1%) 114 (83.2%) 0.877
Age 60 ± 14 60 ± 14
DM 7 (10.1%) 13 (9.5%) 0.881
Anterior MI 41 (60.3%) 83 (60.6%) 0.968
LAD 53 (76.8%) 103 (75.3%) 0.79
LVEF 43 ± 9 45 ± 20
Dyslipidemia 25 (36.2%) 60 (43,8%) 0.298
Hypertension 24 (34.8%) 56 (40.9%) 0.397
Smoking 28 (40.6%) 71 (51.8%) 0.127
AF 3 (4.3%) 3 (2.2%) 0.385
Family Hx 12 (17.4%) 13 (9.5%) 0.101
ASA 9 (13%) 14 (10.2%) 0.54
Results:
The 30-day mortality:
13.00%
2.90%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
VF group no VF
30 day mortality P=0.005
Results:
Long term mortality:
18.80%
11.70%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
20.00%
VF group no VF
long term mortality P=0.16
6.70%
9.00%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
10.00%
VF group no VF
mortality past 30 days P=0.5
Results:
Re-occurrence of ventricular arrhythmias:
1.40% 1.50%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
VF group no VF
re-occurrence of ventricular arrhythmias
P=0.22
Results:
Readmission with re-infarction:
2.90%
8.80%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
10.00%
VF group no VF
Readmission with re-infarction P=0.11
Results:
ICD implantation:
15.00%
6.80%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
VF group no VF
ICD implantation P=0.06
Discussion:
Summary of main results:
• 30-day mortality – higher in the VT/VF group (13.0% vs. 2.9%, p=0.005).
• Long term mortality – similar for both groups (18.8% vs. 11.7%, p=0.16).
• Re-occurrence of ventricular arrhythmias –
no difference between the groups (1.4% vs. 1.5%, p=0.22).
• Readmission with re-infarction –
higher in the control group (8.8% and 2.9%, p=0.11).