What question did this study set out to answer?

To evaluate the incidence, risk patterns, and clinical outcomes of cardiac arrhythmias during the first 24 hours of hospitalization in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

January 10, 2021CureusOpen Access

Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours

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Why the study?

The majority of deaths in acute myocardial infarction are due to arrhythmias, but the incidence, risk factors, and outcomes of cardiac arrhythmias during the first 24 hours of primary PCI needed evaluation.

Key Points

To evaluate the incidence, risk patterns, and clinical outcomes of cardiac arrhythmias during the first 24 hours of hospitalization in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.
Prospective observational study conducted at a cardiovascular center in Pakistan involving 110 patients undergoing primary percutaneous coronary intervention (mean age 59.6±13.1 years; 70.9% male).
Patients were continuously monitored via cardiac telemetry during the first 24 hours of hospitalization to capture arrhythmia episodes across arrival-to-balloon, peri-procedural, and post-procedural intervals.
Arrhythmias occurred in 89.1% of patients across 169 episodes, with accelerated idioventricular rhythm (37.3%), sinus tachycardia (36.4%), ventricular tachycardia (22.7%), and complete heart block (20.0%) as the most frequent subtypes.
Lethal arrhythmias developed in 64.5% of patients, presenting between arrival and balloon inflation in 65.5%, during the procedure in 30.0%, and within 24 hours post-procedure in 53.6%.
Overall in-hospital mortality reached 15.5% and was significantly higher in patients experiencing lethal arrhythmias within 24 hours post-procedure compared to those who did not (21.1% vs. 5.1%; p=0.026).

Structured PICO

Population

110 adults (age 18-80 years) with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), mean age 59.6, 70.9% male, based in Pakistan. Key exclusions: preexisting arrhythmogenic substrate, previously documented history of ACS, prior cardiac or thoracic surgery, prior history of any cardiac intervention, dilated cardiomyopathy, chronic kidney disease (CKD), thyroid diseases, and patients on hemodialysis.

Intervention

Primary percutaneous coronary intervention (PCI) followed by 24-hour telemetry monitoring

Outcome

Incidence of cardiac arrhythmias and in-hospital mortality during the first 24 hours of index hospitalizationhard clinical

In patients with acute myocardial infarction undergoing primary PCI, the incidence of arrhythmias within the first 24 hours is extremely high (89.1%), and the development of lethal arrhythmias is significantly associated with increased in-hospital mortality.

Limitations

Single center-based study
Small sample size
Lack of Holter monitoring
Telemetry monitoring is not a routine clinical practice for all patients at the center, potentially introducing selection bias for high-risk patients

Implication

Close monitoring warranted in first 24 hours post-primary PCI for AMI; leaves open targeted risk stratification.

Abstract

Background Acute myocardial infarction (AMI) is the most life-threatening manifestation of coronary artery diseases. The majority of deaths in AMI are due to arrhythmias. Therefore, the aim of this study was to evaluate the incidence and risk factors and outcomes of cardiac arrhythmias in AMI patients undergoing primary percutaneous coronary intervention (PCI) during the first 24 hours of the index hospitalization. Methodology This prospective observational study was conducted at the adult cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Patients undergoing primary PCI were included in this study. All the patients were kept under observation for the first 24 hours of AMI and monitored through telemetry system monitoring and the incidence of cardiac arrhythmias and the outcomes were recorded. Results A total of 110 patients were included; the mean age was 59.6±13.1 years. Most of them were male (70.9%). Arrhythmias were observed in 89.1% of the patients, with 169 episodes. The accelerated idioventricular rhythm was the most common type of arrhythmia (37.3%) followed by sinus tachycardia (36.4%), ventricular tachycardia (22.7%), and complete heart block (20.0%). Lethal arrhythmias were observed in 64.5% (71) of the patients. During the hospital course, 65.5% developed arrhythmias during arrival to balloon time, 30% during the procedure, and 53.6% within 24 hours of the procedure. The in-hospital mortality rate was 15.5% with a significant association with the development of lethal arrhythmias within 24 hours of the procedure (21.1% vs. 5.1%; p=0.026). Conclusions The incidence of arrhythmias within 24 hours of hospitalization is high in patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI, and it has been observed to be associated with an increased rate of in-hospital mortality.

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Published by Cureus · CC BY

Cite This Study

Shah et al. (2021) studied this question.

synapsesocial.com/papers/6a73920f1aa2fc9e78fb6a26 https://doi.org/10.7759/cureus.12599

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Implication

Close monitoring warranted in first 24 hours post-primary PCI for AMI; leaves open targeted risk stratification.

Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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