Incidence, predictors, and prognostic impact of reperfusion-related ventricular arrhythmias in STEMI patients undergoing primary percutaneous coronary intervention

Reperfusion-induced ventricular arrhythmias (VAs) are a common yet under-recognized complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Their clinical impact and predictors remain incompletely understood. This study aimed to evaluate the incidence, distribution, risk factors, and prognostic significance of reperfusion-related VAs in a contemporary STEMI population treated with PPCI. We retrospectively analyzed 736 STEMI patients who underwent PPCI between 2018 and 2023. Continuous telemetry monitoring was used to detect VAs, including premature ventricular contractions (PVCs), accelerated idioventricular rhythm (AIVR), non-sustained ventricular tachycardia (NSVT), sustained ventricular tachycardia (VT), and ventricular fibrillation (VF). Logistic regression models were applied to identify independent predictors of VA occurrence and assess their association with in-hospital major adverse cardiovascular events (MACE). VAs were observed in 48.8% of patients, with frequent PVCs (43.7%) and AIVR (18.9%) being the predominant subtypes. Multivariate analysis identified extensive anterior infarction and left anterior descending artery (LAD) involvement as independent predictors of VA development (p = 0.032). The presence of VAs was significantly associated with higher rates of in-hospital MACE, including cardiac death, recurrent myocardial infarction, and urgent target vessel revascularization. Reperfusion-related VAs are common following PPCI for STEMI and carry a substantial adverse prognostic impact. Early identification of high-risk patients based on infarct characteristics and continuous arrhythmia monitoring is essential to improve clinical outcomes. Further prospective studies are warranted to refine management strategies targeting reperfusion arrhythmias.