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. 2023 Mar 30;25(3):931-939.
doi: 10.1093/europace/euac242.

Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status

Anna F Thomsen  1 , Christian Jøns  1 , Reza Jabbari  1 , Mia R Jacobsen  1 , Niels Kjær Stampe  1 , Jawad H Butt  1 , Niels Thue Olsen  2 , Henning Kelbæk  3 , Christian Torp-Pedersen  4 , Emil L Fosbøl  1 , Frants Pedersen  1 , Lars Køber  1 , Thomas Engstrøm  1 , Peter Karl Jacobsen  1
Affiliations

Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status

Anna F Thomsen et al. Europace. .

Abstract

Aims: Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia.

Methods and results: Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07-1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00-1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10-2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05-1.53; P = 0.01). All HRs adjusted.

Conclusion: Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR.

Keywords: All-cause mortality; Cardiac arrhythmia; Complete revascularization; Ischaemic heart disease; Percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest: C.T.-P. reports research grants from Novo Nordisk and Bayer. L.K. reports speakers’ fees from AstraZeneca, Novo Nordisk, Novartis, and Boehringer. T.E. reports speakers fee from Abbott. C.J. reports honoraria from Biotronik Inc. and speakers fee from Abbott. J.H.B. reports advisory board honoraria from Bayer, outside the submitted work. The other authors have no financial conflicts of interest to declare.

Figures

Graphical Abstract
Graphical Abstract
Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status. Created with BioRender.com.
Figure 1
Figure 1
Flowchart of the study population including inclusion and exclusion criteria. A total of 5103 patients were included of whom 4009 had CR and 1.094 had ICR. CABG, coronary artery bypass graft surgery; CR, complete revascularization, ICR, incomplete revascularization; PPCI, primary percutaneous intervention; STEMI, ST-segment elevation myocardial infarction.
Figure 2
Figure 2
CIF curves depicting the absolute risk of (A) any arrhythmic event, (B) AF, (C) ventricular tachycardia or CA, (D) sinoatrial or atrioventricular block or (E) all-cause mortality over time divided into CR (n = 4009) and ICR (n = 1094). Year 0: 7 days post-PPCI. AF, atrial fibrillation; CA, cardiac arrest; CIF, cumulative incidence function; CR/ICR, complete/incomplete revascularization; PPCI, primary percutaneous coronary intervention.
See this image and copyright information in PMC

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