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:

Time to VF/VT:

82%

5%

13%

Time to VF/VT

pre PCI during PCI post PCI

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).

Conclusion:

• Malignant ventricular arrhythmias occurring within 48 hours of a STEMI treated with PCI are associated with increased 30-day mortality rate.

• primary VT/VF does not affect long-term outcome in patients discharged alive.

Future directions:

• Phone inquiry.