Key result
Ventricular arrhythmias during acute coronary syndrome increased the risk of subsequent ventricular arrhythmias (HR 4.15; 95% CI 2.42-7.09), while cardiac arrest increased long-term mortality.
Why the study?
A minority of ACS cases are associated with ventricular arrhythmias and/or cardiac arrest, and their effect on long-term outcomes remains to be clarified.
Does the presence of ventricular arrhythmias or cardiac arrest at the time of acute coronary syndrome increase the risk of subsequent arrhythmias and mortality in patients surviving to discharge?
Cohort (n=13,444)
Yes
Does the presence of ventricular arrhythmias or cardiac arrest at the time of acute coronary syndrome increase the risk of subsequent arrhythmias and mortality in patients surviving to discharge?
Hazard Ratio: 4.15 (95% CI 2.42–7.09)
Patients surviving to discharge after experiencing ventricular arrhythmias or cardiac arrest during an acute coronary syndrome have a significantly higher risk of subsequent arrhythmias, and those with cardiac arrest have increased long-term mortality.
Identifies acute-phase ventricular arrhythmias as a strong prognostic marker for long-term recurrence;.
Background A minority of acute coronary syndrome (ACS) cases are associated with ventricular arrhythmias (VA) and/or cardiac arrest (CA). We investigated the effect of VA/CA at the time of ACS on long-term outcomes. Methods and Results We analyzed routine clinical data from 5 National Health Service trusts in the United Kingdom, collected between 2010 and 2017 by the National Institute for Health Research Health Informatics Collaborative. A total of 13 444 patients with ACS, 376 (2.8%) of whom had concurrent VA, survived to hospital discharge and were followed up for a median of 3.42 years. Patients with VA or CA at index presentation had significantly increased risks of subsequent VA during follow-up (VA group: adjusted hazard ratio [HR], 4.15 [95% CI, 2.42-7.09]; CA group: adjusted HR, 2.60 [95% CI, 1.23-5.48]). Patients who suffered a CA in the context of ACS and survived to discharge also had a 36% increase in long-term mortality (adjusted HR, 1.36 [95% CI, 1.04-1.78]), although the concurrent diagnosis of VA alone during ACS did not affect all-cause mortality (adjusted HR, 1.03 [95% CI, 0.80-1.33]). Conclusions Patients who develop VA or CA during ACS who survive to discharge have increased risks of subsequent VA, whereas those who have CA during ACS also have an increase in long-term mortality. These individuals may represent a subgroup at greater risk of subsequent arrhythmic events as a result of intrinsically lower thresholds for developing VA.
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Sau et al. (2022) conducted a cohort in Acute Coronary Syndrome (n=13,444). Ventricular arrhythmias or cardiac arrest vs. No ventricular arrhythmias or cardiac arrest was evaluated on Subsequent ventricular arrhythmias (HR 4.15, 95% CI 2.42-7.09). Ventricular arrhythmias during acute coronary syndrome increased the risk of subsequent ventricular arrhythmias (HR 4.15; 95% CI 2.42-7.09), while cardiac arrest increased long-term mortality.
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