Aims: This study sought to assess the prognostic impact of coronary chronic total occlusions (CTO) in patients presenting with ventricular tachyarrhythmias on admission.Methods and results: A large retrospective registry was used, including all consecutive patients presenting with ventricular tachyarrhythmias on admission and undergoing coronary angiography from 2002 to 2016. Patients with a CTO were compared with all other patients (non-CTO) for prognostic outcomes. Statistics comprised Kaplan-Meier and Cox regression analyses. Within a total of 1,461 consecutive patients included with ventricular tachyarrhythmias on admission, a CTO was present in 20%. At midterm follow-up of 18 months, the primary endpoint all-cause mortality had occurred in 40% of CTO patients compared to 27% of non-CTO patients (HR 1.563, 95% CI: 1.263-1.934; p=0.001). The rates of secondary endpoints were higher for in-hospital all-cause mortality at index (29% versus 20%, log-rank p=0.027) and the composite endpoint of cardiac death at 24 hours, recurrent ventricular tachyarrhythmias and appropriate ICD therapies at midterm follow-up (28% versus 20%, log-rank p=0.005). Mortality rates were highest in CTO patients with stable coronary artery disease (CAD), acute myocardial infarction and in patients surviving index hospitalisation.
Conclusions:In patients presenting with ventricular tachyarrhythmias on admission, the presence of a coronary CTO is independently associated with an increase of midterm all-cause mortality, in-hospital allcause mortality and the composite endpoint of early cardiac death, recurrent ventricular tachyarrhythmias and appropriate ICD therapies.
Heterogenous data about the prognostic impact of atrial fibrillation (AF) in patients with ventricular tachyarrhythmias exist. Therefore, this study evaluates this impact of AF in patients presenting with ventricular tachyarrhythmias. 1,993 consecutive patients presenting with ventricular tachyarrhythmias (i.e. ventricular tachycardia and fibrillation (VT, VF)) on admission at one institution were included (from 2002 until 2016). All medical data of index and follow-up hospitalizations were collected during the complete follow-up period for each patient. Statistics comprised univariable Kaplan-Meier and multivariable Cox regression analyses in the unmatched consecutive cohort and after propensity-score matching for harmonization. The primary prognostic endpoint was long-term all-cause mortality at 2.5 years. AF was present in 31% of patients presenting with index ventricular tachyarrhythmias on admission (70% paroxysmal, 9% persistent, 21% permanent). VT was more common (67% versus 59%; p = 0.001) than VF (33% versus 41%; p = 0.001) in AF compared to non-AF patients. Long-term all-cause mortality at 2.5 years occurred more often in AF compared to non-AF patients (mortality rates 40% versus 24%, log rank p = 0.001; HR = 1.825; 95% CI 1.548–2.153; p = 0.001), which may be attributed to higher rates of all-cause mortality at 30 days, in-hospital mortality and mortality after discharge (p < 0.05) (secondary endpoints). Mortality differences were observed irrespective of index ventricular tachyarrhythmia (VT or VF), LV dysfunction or presence of an ICD. In conclusion, this study identifies AF as an independent predictor of death in patients presenting consecutively with ventricular tachyarrhythmias.
Background
Ventricular tachyarrhythmias are still associated with poor clinical outcomes. Therefore, it is important to stratify high‐risk patients presenting with ventricular tachyarrhythmias for their individual risk of future outcomes.
Aim
To assess the impact of male sex on survival in patients presenting with ventricular tachyarrhythmias.
Methods
All consecutive patients surviving ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016 were included and stratified according to sex differences by propensity score matching. The primary prognostic end‐point was all‐cause mortality at 30 months. Secondary end‐points were all‐cause mortality at 30 days, at index hospitalisation, after discharge, the composite of recurrent ventricular tachyarrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapies, and finally rehospitalisation related to ventricular tachyarrhythmias.
Results
A total of 784 (392 males and 392 females) matched patients was included. The rate of VT and VF was similar in both groups (VT: male 65% vs female 62%; VF: male 35% vs female 38%). Male sex was independently associated with the primary end‐point of all‐cause mortality at 30 months (31% vs 23%; hazard ratio (HR) = 1.432; 95% confidence interval (CI) 1.089–1.883; P = 0.010) as well as with the secondary end‐point of all‐cause mortality at index hospitalisation (mortality rate 31% vs 23%; log‐rank P = 0.010; HR = 1.432; 95% CI 1.089–1.883; P = 0.010; mortality rate 10% vs 15%; HR = 1.685; 95% CI 1.117–2.542; P = 0.013). No differences in further secondary end‐points were found. Sex differences of the primary end‐point were predominantly observed in patients with VT at index (mortality rate 28% versus 20%; HR = 1.512; 95% CI 1.040–2.189; P = 0.028), without an ICD and with left ventricular ejection fraction ≥35% (log‐rank values, P < 0.05).
Conclusion
Males presenting with ventricular tachyarrhythmias on admission were associated with higher all‐cause mortality at 30 months and all‐cause mortality at index hospitalisation.
Acute myocardial infarction and coronary artery disease (CAD) are the most common causes for the development of malignant arrhythmia often leading to cardiogenic shock and cardiac arrest. Structural heart disease represents the main pathology in older patients, whereas young adults mostly suffer from cardiomyopathies and channelopathies. This book chapter delineates modern interventional therapies for patients with cardiogenic shock or aborted cardiac arrest. Epidemiological data on the incidence of malignant arrhythmia depending causing cardiac arrest depending on the presence or absence of CAD and myocardial infarction are presented. Realistic difficulties within clinical decision-making are counterbalanced for and against an early, aggressive and invasive therapeutic approach including early coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management and mechanical cardiac assist devices, depending on the individual clinical presentation and underlying cardiac arrhythmia.
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