Incidence of and Outcomes Associated With Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

RIOR INVESTIGATORS HAVE EVALUated the clinical and angiographic features and outcomes associated with ventricular tachycardia or fibrillation (VT/VF) in patients with ST-elevation myocardial infarction (STEMI) receiving fibrinolysis. 1-6 These studies have suggested that the occurrence of VT/VF in this cohort is associated with poor in-hospital and long-term adverse outcomes, irrespective of the timing of their occurrence: ie, early (Յ48 hours) vs late (Ͼ48 hours) after their symptom onset. 1-6 Similarly, a prior study has identified the clinical and angiographic correlates and outcomes of VT/VF occurring in the cardiac catheterization laboratory among patients undergoing primary percutaneous coronary intervention (PCI). 7 However, this study analyzed low-risk patients (without renal failure or cardiogenic shock) enrolled before 1999, when stents and glycoprotein IIb/IIIa receptor antagonists were not routinely used, and focused only on VT/VF occurring in the cardiac catheterization laboratory, Context The incidence and timing of sustained ventricular tachycardia or fibrillation (VT/VF) and its impact on outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are poorly understood. Objective To evaluate the association of sustained VT/VF and its timing on the outcomes of patients presenting for primary PCI-an aim not prespecified in the APEX AMI trial. Design, Setting, and Patients We studied 5745 STEMI patients presenting for primary PCI at 296 hospitals in 17 countries between July 13, 2004, and May 11, 2006, from the APEX AMI trial. We categorized them into 4 groups: no VT/VF; VT/VF any time; early VT/VF, before the end of cardiac catheterization; and late VT/VF, after the end of cardiac catheterization. Main Outcome Measure Ninety-day total mortality. Results VT/VF occurred in 329 STEMI patients (5.7%) presenting for primary PCI. The majority of these occurred before the end of catheterization (n=205, 64%), and 90% occurred within 48 hours of presentation with symptoms of STEMI. Clinical outcomes were worse in patients with vs those without VT/VF (90-day mortality, 23.2% vs 3.6%; adjusted HR, 3.63; 95% CI, 2.59-5.09), and outcomes were worse if the VT/VF occurred late instead of early (90-day mortality for early VT/VF, 17.2% [adjusted HR, 2.34; 95% CI, 1.44-3.80]; for late VT/VF, 33.3% [adjusted HR, 5.59; 95% CI, 3.71-8.43]; for no VT/VF, 3.6% [referent]). In multivariate analyses, factors associated with early VT/VF included pre-PCI thrombolysis in MI (TIMI) flow grade 0 (HR, 2.94; 95% CI, 1.93-4.47), inferior infarction (HR, 2.16; 95% CI, 1.58-2.93), total baseline ST deviation (HR, 1.39; 95% CI, 1.19-1.63), creatinine clearance (HR, 0.88; 95% CI, 0.83-0.94), Killip class greater than I (HR, 1.88; 95% CI, 1.29-2.76), baseline systolic blood pressure (HR, 0.92; 95% CI, 0.87-0.98), body weight (HR, 1.16; 95% CI, 1.04-1.29), and baseline heart rate greater than 70/min (HR, 1.10; 95% CI, 1.01-1.20) (c index, 0.75). Factors related to late ...

Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era

“…For example, patients with sustained acute-phase VT are reported to have higher in-hospital cardiac mortality rates, but had similar 1-year rates after discharge than those with nonsustained VT. 2 In addition, the 90-day mortality rate was higher if acute-phase VT/VF occurred after PCI than before PCI. 17 Thus, acute-phase VT/VF, as defined in the present study, may have had low prognostic significance.…”

“…18, 19 In addition to these factors, lesions in the right coronary artery were also associated with acute-phase VT/VF, as was found in the APEX-AMI study. 17 Notably, diabetes mellitus was associated 12 h of symptom onset and underwent primary PCI, the incidence of acute-phase VT/VF was 23.3%. Notably, although acute-phase VT/VF was associated with an increased risk of in-hospital death, it was only associated with increased 5-year mortality rate after hospital discharge among patients with high baseline risk.…”

Protective effects of saffron (Crocus sativus) against lethal ventricular arrhythmias induced by heart reperfusion in rat: A potential anti-arrhythmic agent

“…Previous studies reported that sustained ventricular tachycardia or fibrillation (VT/VF) occurred in more than 5% of patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI (Mehta et al, 2009(Mehta et al, , 2012 and the occurrence of VT/VF was associated with increased 90-day mortality (Mehta et al, 2009). Reperfusion-induced arrhythmias were also observed in 30% of patients with successful reperfusion by streptokinase thrombolysis (Buckingham et al, 1986).…”

Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia

“…In monomorphic VT, 70% of cases are caused by ischemic heart disease and 20% by other structural disease (including dilated nonischemic cardiomyopathy, valvular or congenital heart disease, sarcoidosis, and Chagas disease); 10% are idiopathic. 3 Most VT is due to a reentrant circuit at the border of a myocardial scar and is usually monomorphic, although acute myocardial infarction can sometimes also cause polymorphic VT. 4,5 This contrasts with idiopathic VT, which usually originates from the right ventricular (RV) or left ventricular (LV) outflow tract and typically presents in adolescents. 6 Genetic disorders such as long QT or Brugada syndrome can predispose patients to polymorphic VT. 7 Table I shows causes of arrhythmias.…”