Thrombolytic Therapy can Reduce the Arrhythmogenic Substrate After Acute Myocardial Infarction
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Key result
Early reperfusion achieved by thrombolytic therapy significantly reduced the incidence of inducible sustained monomorphic ventricular tachycardia to 20% compared to 44% in patients with failed reperfusion.
Why the study?
Does successful early reperfusion by thrombolytic therapy reduce the arrhythmogenic substrate and improve electrical stability in patients with a first acute myocardial infarction?
Population
93 consecutive patients admitted within 6h of first acute myocardial infarction with TIMI 0 or 1 flow…
Comparison
Successful early reperfusion following… vs Failed early reperfusion despite receiving the…
Design
Cohort
Follow-up
mean 16.4 months for group 1, 14.9 months for group 2
Authors
Discussion
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Implication
May support lower post-MI VT inducibility with early reperfusion; hypothesis-generating for electrical stability, needs RCTs.
Study Design
Type
Cohort (n=93)
Multicenter
No
Structured PICO
Does successful early reperfusion by thrombolytic therapy reduce the arrhythmogenic substrate and improve electrical stability in patients with a first acute myocardial infarction?
P
Population
93 consecutive patients (80 men, 13 women, mean age 59.6) admitted within 6h of first acute myocardial infarction (AMI) with TIMI 0 or 1 flow. Excluded: >75 years, bundle branch block, atrial fibrillation, or contraindications to thrombolysis.
I
Intervention
Successful early reperfusion (TIMI grade 2 or 3 flow) following thrombolytic therapy (intracoronary urokinase 960,000 units over 40min or recombinant tissue-type plasminogen activator 100mg over 40min) (n=75).
C
Comparator
Failed early reperfusion (TIMI grade 0 or 1 flow) despite receiving the same thrombolytic therapy (n=18).
O
Outcome
Electrophysiologic effects including incidence of signal-averaged ECG abnormalities (late potentials), delayed endocardial electrograms on catheter mapping, and inducible sustained monomorphic ventricular tachycardia on programmed stimulation.surrogate
Main Result
Absolute Event Rate: 20% vs 44%
p-value: p=<0.05
Successful early reperfusion with thrombolytic therapy significantly reduces the arrhythmogenic substrate and improves ventricular electrical stability after a first acute myocardial infarction.
Limitations
- Relatively small study population due to the invasiveness of the protocol.
- Endocardial catheter mapping in sinus rhythm has not been validated for post-infarction patients without clinical arrhythmias.
- Did not evaluate the influence of collateral vessels on electrical substrates.
- Inclusion of TIMI grade 2 flow in successful early reperfusion might have affected left ventricular ejection fraction results.
- Small study population due to invasiveness
- Endocardial catheter mapping in sinus rhythm not validated for post-infarction patients without clinical arrhythmias
- Did not evaluate collateral vessels
- Inclusion of TIMI grade 2 flow in successful reperfusion group may have blunted LVEF differences
Cite This Study
Akiyama et al. (1999) conducted a cohort in Acute Myocardial Infarction (n=93). Successful early reperfusion via thrombolytic therapy (urokinase or rt-PA) vs. Failed early reperfusion (TIMI grade 0 or 1) was evaluated on Inducible sustained monomorphic ventricular tachycardia (p=<0.05). Early reperfusion achieved by thrombolytic therapy significantly reduced the incidence of inducible sustained monomorphic ventricular tachycardia to 20% compared to 44% in patients with failed reperfusion.
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