What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (STEMI) (n=4283). Intervention: Acute-phase ventricular tachycardia and/or fibrillation (VT/VF) vs. Absence of acute-phase VT/VF. Primary outcome: In-hospital mortality (HR 1.83, 95% CI 1.27-2.64, p=0.0013).

January 1, 2016Circulation JournalOpen Access

Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era

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Key result

Acute-phase ventricular tachycardia and/or fibrillation was associated with a significantly higher risk of in-hospital mortality (14.6% vs. 4.3%, HR 1.83) in STEMI patients undergoing primary PCI.

Why the study?

Does acute-phase VT/VF increase in-hospital and 5-year mortality in STEMI patients undergoing emergency PCI?

Study Design

Type

Observational (n=4,283)

Multicenter

Yes

Structured PICO

Does acute-phase VT/VF increase in-hospital and 5-year mortality in STEMI patients undergoing emergency PCI?

Population

4,283 consecutive patients with ST-segment elevation myocardial infarction who underwent emergency percutaneous coronary intervention within 12 hours of symptom onset, followed for up to 5 years.

Exposure

Acute-phase ventricular tachycardia and fibrillation (VT/VF), defined as ≥3 consecutive ventricular premature complexes and/or VF within the 1st week of hospitalization

Comparator

Patients without acute-phase VT/VF

Outcome

In-hospital mortality and 5-year mortality rateshard clinical

Main Result

Hazard Ratio: 1.83 (95% CI 1.27–2.64)

Absolute Event Rate: 14.6% vs 4.3%

p-value: p=0.0013

Acute-phase VT/VF in STEMI patients undergoing primary PCI is associated with increased in-hospital mortality, but its long-term prognostic impact is limited to high-risk patients.

Limitations

Acute-phase VT/VF events, as defined in the study, were relatively conclusive and may have limited prognostic significance.
Did not collect data on late ventricular arrhythmias that occurred beyond 7 days of AMI onset.
Left ventricular ejection fraction was not included in the multivariate analyses because of missing data.
Not all data related to specific treatments for arrhythmia, such as antiarrhythmic drug usage and ICD implantation, were available.

Implication

May prompt closer acute monitoring in STEMI with VT/VF; leaves open independent long-term prognostic value beyond high-risk subgroups.

Abstract

BACKGROUND: The aim of this study was to investigate the prognostic impact of acute-phase ventricular tachycardia and fibrillation (VT/VF) on ST-segment elevation myocardial infarction (STEMI) patients in the percutaneous coronary intervention (PCI) era. METHODS AND RESULTS: Using the database of the Osaka Acute Coronary Insufficiency Study (OACIS), we studied 4,283 consecutive patients with STEMI who were hospitalized within 12 h of STEMI onset and underwent emergency PCI. Acute-phase VT/VF, defined as ≥3 consecutive ventricular premature complexes and/or VF within the 1st week of hospitalization, occurred in 997 (23.3%) patients. In-hospital mortality risk was significantly higher in patients with acute-phase VT/VF than inthose without (14.6% vs. 4.3%, adjusted hazard ratio (HR) 1.83, P=0.0013). Among patients discharged alive, 5-year mortality rates were comparable between patients with and without acute-phase VT/VF. Subgroup analysis showed that acute-phase VT/VF was associated with increased 5-year mortality after discharge in high-risk patients (GRACE Risk Score ≥115; adjusted HR 1.60, P=0.043), but not in intermediate- or low-risk patients. CONCLUSIONS: Even in the PCI era, acute-phase VT/VF was associated with higher in-hospital deaths of STEMI patients. However, the 5-year prognostic impact of acute-phase VT/VF was limited to high-risk patients. (Circ J 2016; 80: 1539-1547).

Discussion

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Cite This Study

Masuda et al. (2016) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=4,283). Acute-phase ventricular tachycardia and/or fibrillation (VT/VF) vs. Absence of acute-phase VT/VF was evaluated on In-hospital mortality (HR 1.83, 95% CI 1.27-2.64, p=0.0013). Acute-phase ventricular tachycardia and/or fibrillation was associated with a significantly higher risk of in-hospital mortality (14.6% vs. 4.3%, HR 1.83) in STEMI patients undergoing primary PCI.

synapsesocial.com/papers/6a93da8f1e998d99dafec6db https://doi.org/10.1253/circj.cj-16-0183