Key result
In patients presenting with ventricular tachyarrhythmias and sudden cardiac arrest, non-AMI (vs AMI) was associated with higher 2.5-year all-cause mortality (55% vs 43%; HR 1.349, P=0.001).
Why the study?
Does the presence of acute myocardial infarction (AMI) and its subtype (STEMI vs NSTEMI) impact long-term mortality in patients presenting with ventricular tachyarrhythmias and sudden cardiac arrest?
Cohort (n=2,813)
Does the presence of acute myocardial infarction (AMI) and its subtype (STEMI vs NSTEMI) impact long-term mortality in patients presenting with ventricular tachyarrhythmias and sudden cardiac arrest?
Hazard Ratio: 1.349
Absolute Event Rate: 55% vs 43%
p-value: p=0.001
In patients presenting with ventricular tachyarrhythmias and sudden cardiac arrest, the absence of AMI, or the presence of NSTEMI rather than STEMI, is associated with significantly higher long-term mortality.
Non-AMI and NSTEMI linked to higher mortality in VT/VF/SCA; leaves open whether etiology-specific strategies warrant prospective testing.
Background The study sought to assess the prognostic impact of acute myocardial infarction ( AMI ) with and without ST -segment-elevation myocardial infarction ( STEMI and NSTEMI ) in patients with ventricular tachyarrhythmias and sudden cardiac arrest ( SCA ) on admission. Methods and Results A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia ( VT ), fibrillation ( VF ), and sudden cardiac arrest ( SCA ) on admission from 2002 to 2016. AMI versus non- AMI and STEMI versus NSTEMI were compared applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic end point defined as long-term all-cause mortality at 2.5 years. Secondary end points were 30 days all-cause mortality, cardiac death at 24 hours, in hospital death, and recurrent percutaneous coronary intervention (re- PCI ) at 2.5 years. In 2813 unmatched high-risk patients with ventricular tachyarrhythmias and SCA , AMI was present in 29% (10% STEMI , 19% NSTEMI ) with higher rates of VF (54% versus 31%) and SCA (35% versus 26%), whereas VT rates were higher in non- AMI (56% versus 30%) ( P < 0.05). AMI -related VT ≥48 hours was associated with higher mortality (log rank P = 0.001). Multivariable Cox regression models revealed non- AMI (hazard ratio = 1.458; P = 0.001) and NSTEMI (hazard ratio = 1.460; P = 0.036) associated with increasing long-term all-cause mortality at 2.5 years, which was also proven after propensity-score matching (non- AMI versus AMI : 55% versus 43%, log rank P = 0.001, hazard ratio = 1.349; NSTEMI versus STEMI : 45% versus 34%, log rank P = 0.047, hazard ratio = 1.372). Secondary end points including 30 days and in-hospital mortality, as well as re- PCI were higher in non- AMI patients. Conclusions In high-risk patients presenting with ventricular tachyarrhythmias and SCA , non- AMI revealed higher mortality than AMI , respectively NSTEMI than STEMI , alongside AMI -related VT ≥48 hours.
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Behnes et al. (2018) conducted a cohort in Ventricular tachyarrhythmias and sudden cardiac arrest (n=2,813). Non-acute myocardial infarction (non-AMI) vs. Acute myocardial infarction (AMI) was evaluated on long-term all-cause mortality at 2.5 years (HR 1.349, p=0.001). In patients presenting with ventricular tachyarrhythmias and sudden cardiac arrest, non-AMI (vs AMI) was associated with higher 2.5-year all-cause mortality (55% vs 43%; HR 1.349, P=0.001).
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