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Prognostic Value of Early Sustained Ventricular Arrhythmias in ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention : A Substudy of VALIDATE-SWEDEHEART Trial

Demidova, Marina M. LU ; Rylance, Rebecca LU ; Koul, Sasha LU ; Dworeck, Christian ; James, Stefan ; Aasa, Mikael ; Hamid, Mehmet ; Swahn, Eva ; Hambraeus, Kristina and Danielewicz, Mikael , et al. (2023) In Heart Rhythm O2 4(3). p.200-206
Abstract

Background: Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (<48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia. Objective: We analyzed the prognostic value of early ventricular arrhythmias (VAs) in STEMI with regard to their type and timing. Methods: The prespecified analysis of the multicenter prospective Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarctionin Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of... (More)

Background: Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (<48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia. Objective: We analyzed the prognostic value of early ventricular arrhythmias (VAs) in STEMI with regard to their type and timing. Methods: The prespecified analysis of the multicenter prospective Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarctionin Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease evaluated according to Recommended Therapies Registry Trial included 2886 STEMI patients undergoing primary percutaneous coronary intervention (PCI). VA episodes were characterized regarding their type and timing. Survival status at 180 days was assessed through the population registry. Results: Nonmonomorphic VT or VF was observed in 97 (3.4%) and monomorphic VT in 16 (0.5%) patients. Only 3 (2.7%) early VA episodes occurred after 24 hours from symptom onset. VA was associated with higher risk of death (hazard ratio 3.59; 95% confidence interval [CI] 2.01–6.42) after adjustment for age, sex, and STEMI localization. VA after PCI was associated with an increased mortality compared with VA before PCI (hazard ratio 6.68; 95% CI 2.90–15.41). Early VA was associated with in-hospital mortality (odds ratio 7.39; 95% CI 3.68–14.83) but not with long-term prognosis in patients discharged alive. The type of VA was not associated with mortality. Conclusion: VA after PCI was associated with an increased mortality compared with VA before PCI. Long-term prognosis did not differ between patients with monomorphic VT and nonmonomorphic VT or VF, but events were few. VA incidence during 24 to 48 hours of STEMI is negligibly low, thus precluding assessment of its prognostic importance.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Monomorphic ventricular tachycardia, PCI, STEMI, Ventricular arrhythmias, Ventricular fibrillation
in
Heart Rhythm O2
volume
4
issue
3
pages
200 - 206
publisher
Elsevier
external identifiers
  • scopus:85148723966
  • pmid:36993916
ISSN
2666-5018
DOI
10.1016/j.hroo.2022.12.008
language
English
LU publication?
yes
id
07ffee7d-9c35-4c29-865c-502ba434dfe6
date added to LUP
2023-03-17 12:34:52
date last changed
2024-06-13 14:24:54
@article{07ffee7d-9c35-4c29-865c-502ba434dfe6,
  abstract     = {{<p>Background: Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (&lt;48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia. Objective: We analyzed the prognostic value of early ventricular arrhythmias (VAs) in STEMI with regard to their type and timing. Methods: The prespecified analysis of the multicenter prospective Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarctionin Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease evaluated according to Recommended Therapies Registry Trial included 2886 STEMI patients undergoing primary percutaneous coronary intervention (PCI). VA episodes were characterized regarding their type and timing. Survival status at 180 days was assessed through the population registry. Results: Nonmonomorphic VT or VF was observed in 97 (3.4%) and monomorphic VT in 16 (0.5%) patients. Only 3 (2.7%) early VA episodes occurred after 24 hours from symptom onset. VA was associated with higher risk of death (hazard ratio 3.59; 95% confidence interval [CI] 2.01–6.42) after adjustment for age, sex, and STEMI localization. VA after PCI was associated with an increased mortality compared with VA before PCI (hazard ratio 6.68; 95% CI 2.90–15.41). Early VA was associated with in-hospital mortality (odds ratio 7.39; 95% CI 3.68–14.83) but not with long-term prognosis in patients discharged alive. The type of VA was not associated with mortality. Conclusion: VA after PCI was associated with an increased mortality compared with VA before PCI. Long-term prognosis did not differ between patients with monomorphic VT and nonmonomorphic VT or VF, but events were few. VA incidence during 24 to 48 hours of STEMI is negligibly low, thus precluding assessment of its prognostic importance.</p>}},
  author       = {{Demidova, Marina M. and Rylance, Rebecca and Koul, Sasha and Dworeck, Christian and James, Stefan and Aasa, Mikael and Hamid, Mehmet and Swahn, Eva and Hambraeus, Kristina and Danielewicz, Mikael and Linder, Rikard and Fröbert, Ole and Grimfjärd, Per and Stewart, Jason and Henareh, Loghman and Andersson, Jonas and Wagner, Henrik and Erlinge, David and Platonov, Pyotr G.}},
  issn         = {{2666-5018}},
  keywords     = {{Monomorphic ventricular tachycardia; PCI; STEMI; Ventricular arrhythmias; Ventricular fibrillation}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{200--206}},
  publisher    = {{Elsevier}},
  series       = {{Heart Rhythm O2}},
  title        = {{Prognostic Value of Early Sustained Ventricular Arrhythmias in ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention : A Substudy of VALIDATE-SWEDEHEART Trial}},
  url          = {{http://dx.doi.org/10.1016/j.hroo.2022.12.008}},
  doi          = {{10.1016/j.hroo.2022.12.008}},
  volume       = {{4}},
  year         = {{2023}},
}