Key result
Compared with PCI, non-revascularization in post-MI patients with LVEF <40% increased the long-term risk of new-onset arrhythmia (HR 1.7; P=0.01).
Why the study?
To describe the influence of mode of revascularization on the long-term risk of new-onset arrhythmias and subsequent major cardiovascular events in post-MI patients with reduced ejection fraction.
Does the mode of revascularization (PCI vs thrombolysis or no revascularization) affect the long-term risk of new-onset arrhythmias and subsequent MACE in patients with acute MI and LVEF <40%?
Observational (n=268)
Does the mode of revascularization (PCI vs thrombolysis or no revascularization) affect the long-term risk of new-onset arrhythmias and subsequent MACE in patients with acute MI and LVEF <40%?
In post-MI patients with LVEF <40%, PCI is associated with a lower long-term risk of new-onset arrhythmias and subsequent MACE compared to thrombolysis or no revascularization.
Answers are grounded in this paper and cite their sources.
PCI may lower arrhythmia risk versus non-revascularization in reduced-EF post-MI patients; leaves open need for randomized confirmation before practice change.
AIMS: The Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) study was an observational trial including 312 patients with acute myocardial infarction (MI) and left ventricular ejection fraction (LVEF) <40%. Primary percutaneous intervention (pPCI) was introduced 2 years after start of the enrolment, dividing the population into two groups: pre- and post-pPCI. This substudy sought to describe the influence of the mode of revascularization on long-term risk of new-onset atrial fibrillation (AF), bradyarrhythmia, and ventricular tachycardia and the subsequent risk of relevant major cardiovascular events (MACE). METHODS AND RESULTS: The study included the 268 patients without a history of AF. All patients received an implantable cardiac monitor (ICM) and were followed for 2 years. The choice of revascularization was made by the treating team independently of the trial and retrospectively divided into pPCI, subacute PCI, primary thrombolysis, or no revascularization. Endpoints were new-onset arrhythmia and MACE.A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received any PCI. The adjusted hazard ratio (HR) for developing any arrhythmia and the subsequently risk of MACE were increased in non-revascularized or thrombolysed patients compared with PCI-patients (any arrhythmia, non-revascularization: HR = 1.7, P = 0.01 and thrombolysis: HR = 1.6, P = 0.05; MACE, non-revascularization: HR = 3.1, P = 0.05 and thrombolysis: HR = 3.1, P = 0.08). All HRs were adjusted for significant baseline and clinically considered covariates and stratified for calendar year. CONCLUSION: This study is the first to demonstrate that the long-term risk of arrhythmia documented by an ICM and the subsequent risk of MACE were increased in non-revascularized or thrombolysed patients compared with PCI-patients in a post-MI population with LVEF <40%.
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Thomsen et al. (2020) conducted an observational in Acute myocardial infarction with LVEF <40% (n=268). Non-revascularization or thrombolysis vs. Percutaneous coronary intervention (PCI) was evaluated on Any new-onset arrhythmia (HR 1.7, p=0.01). Compared with PCI, non-revascularization in post-MI patients with LVEF <40% increased the long-term risk of new-onset arrhythmia (HR 1.7; P=0.01).
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