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. 2022 Dec 22;4(3):200-206.
doi: 10.1016/j.hroo.2022.12.008. eCollection 2023 Mar.

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

Marina M Demidova  1 , Rebecca Rylance  1 , Sasha Koul  1 , Christian Dworeck  2 , Stefan James  3 , Mikael Aasa  4 , Mehmet Hamid  5 , Eva Swahn  6 , Kristina Hambraeus  7 , Mikael Danielewicz  8 , Rikard Linder  9 , Ole Fröbert  10 , Per Grimfjärd  11 , Jason Stewart  12 , Loghman Henareh  13 , Jonas Andersson  14 , Henrik Wagner  15 , David Erlinge  1 , Pyotr G Platonov  1
Affiliations

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

Marina M Demidova et al. Heart Rhythm O2. .

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 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.

Keywords: Monomorphic ventricular tachycardia; PCI; STEMI; Ventricular arrhythmias; Ventricular fibrillation.

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Figures

Figure 1
Figure 1
Timing of ventricular tachycardia or ventricular fibrillation (VT/VF) during acute ST-segment elevation myocardial infarction. Data are presented as the percentage of events in each subgroup. Figures in columns indicate the absolute numbers of events in each subgroup. PCI = percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan-Meier failure curves: total mortality with regard to arrhythmia timing. PCI = percutaneous coronary intervention; VA = ventricular arrhythmia.
Figure 3
Figure 3
Kaplan-Meier failure curves: total mortality with regard to arrhythmia type (nonshockable rhythm excluded). MMVT = monomorphic ventricular tachycardia; PMVT = polymorphic ventricular tachycardia; VA = ventricular arrhythmia; VF = ventricular fibrillation.
See this image and copyright information in PMC

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