Cardiogenic shock (HR 3.5), new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior MI (HR 1.6) and symptom-to-balloon time >3 h (HR 1.3) independently predicted VF/VT.
Cohort (n=4,200)
What are the clinical predictors of VF/VT in patients with STEMI treated invasively, and how does the timing of arrhythmia impact mortality?
Clinical parameters such as cardiogenic shock and delayed reperfusion can predict VF/VT in STEMI patients, and post-reperfusion arrhythmias carry a significantly worse long-term prognosis than reperfusion-induced arrhythmias.
OBJECTIVES: The primary aim of the study was to evaluate risk factors for ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and to develop the risk score for prediction of VF/VT in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. The secondary aim was to assess the effect of VF/VT on mortality depending on timing of arrhythmia. PATIENTS AND METHODS: We analyzed 4363 consecutive patients with STEMI treated invasively. Among them, 163 patients with pre-reperfusion arrhythmia were excluded from the study. Group ventricular arrhythmias (VA) encompassed patients with VF/VT - those with reperfusion-induced arrhythmia were included into group VA1, whereas group VA2 consisted of patients with postreperfusion arrhythmia. The control group comprised patients free of VF/VT. RESULTS: VF or VT occurred in 313 (7.45%) patients - group VA1 encompassed 103 (32.9%) and group AV2 210 (67.1%) patients. Cardiogenic shock on admission hazard ratio (HR) 3.5, new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior myocardial infarction (HR 1.6) and symptom-to-balloon time more than 3 h (HR 1.3) were the independent predictors of VF/VT occurrence. In group VA2, the in-hospital and long-term mortality were 4- and 1.5-fold higher than in the arrhythmia-free population (20.5 vs. 4.5% and 36.2 vs. 22.6%, respectively; P<0.001). On the contrary, in group VA1, the long-term mortality was not significantly higher compared with the control group (26.2 vs. 22.6%; P=NS), whereas in-hospital mortality was almost three-fold increased (12.5 vs. 4.5%, respectively; P<0.001). CONCLUSION: The risk score based on simple clinical parameters might be useful for risk stratification for VF/VT in patients with STEMI. The predictive value of VF/VT was strongly dependent on timing of arrhythmia.
Podolecki et al. (Wed,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=4,200). Risk factors for VF/VT vs. Patients without risk factors was evaluated on Ventricular fibrillation/sustained ventricular tachycardia (VF/VT). Cardiogenic shock (HR 3.5), new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior MI (HR 1.6) and symptom-to-balloon time >3 h (HR 1.3) independently predicted VF/VT.