Key result
Ventricular arrhythmias in ACS undergoing PCI link to ~5-fold higher short-term mortality.
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Why the study?
Ventricular arrhythmias often complicate ACS, but the prognostic impact of their timing relative to PCI remained unclear.
Does the occurrence and timing of ventricular arrhythmias relative to percutaneous coronary intervention increase short-term and long-term all-cause mortality in patients with acute coronary syndromes?
Meta-Analysis (n=49,963)
Does the occurrence and timing of ventricular arrhythmias relative to percutaneous coronary intervention increase short-term and long-term all-cause mortality in patients with acute coronary syndromes?
Odds Ratio: 5.04 (95% CI 3.78–6.72)
In patients with ACS undergoing PCI, peri-procedural ventricular arrhythmias substantially increase short- and long-term mortality, with post-PCI arrhythmias carrying the highest short-term risk, though survivors to 30 days/discharge face no excess long-term mortality.
BACKGROUND: Ventricular arrhythmias (VA) often complicate acute coronary syndromes (ACS). The prognostic impact of VA timing relative to percutaneous coronary intervention (PCI) remains unclear. OBJECTIVE: To assess the prognostic significance of VA based on their timing of occurrence in relation to PCI. METHODS: Systematic review and meta-analysis of observational studies reporting all-cause mortality with and without VA (sustained or hemodynamically unstable VT/VF) in ACS patients undergoing PCI. The endpoints analyzed were short-term (30 days/in-hospital) and long-term (1 year) mortality. A network meta-analysis comparing VA-before PCI, VA-during PCI, and VA-after PCI with the group not experiencing VA as a reference was conducted. RESULTS: Twelve studies comprising 49,963 patients were included, of whom 3,475 (7.0%) experienced VA. VA was associated with increased short- (OR 5.04, 95%CI 3.78-6.72) and long-term mortality (OR 2.92, 95%CI 2.20-3.86). In patients alive at discharge/30 days, subsequent long-term mortality risk did not differ between those with and without VA (OR 0.97, 95%CI 0.62-1.52). The network meta-analysis showed that all VA timings are associated with a significantly higher risk compared with the group not experiencing VA. Sensitivity analysis found that VA-after is associated with higher short-term mortality than earlier VA (OR 3.37, 95%CI 1.46-7.82). CONCLUSIONS: VA substantially increase the risk of death in patients with ACS undergoing PCI. Mortality risk emerges to be associated with the timing of VA occurrence, with VA-after PCI associated with the highest risk. These findings highlight the prognostic relevance of arrhythmic events across the entire peri-procedural window, underscoring the need for refined risk stratification.
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Pizzi et al. (2026) conducted a meta-analysis in Acute coronary syndromes undergoing percutaneous coronary intervention (n=49,963). Ventricular arrhythmias (before, during, or after PCI) vs. No ventricular arrhythmias was evaluated on Short-term (30 days/in-hospital) all-cause mortality (OR 5.04, 95% CI 3.78-6.72). Ventricular arrhythmias in ACS patients undergoing PCI increased short-term (OR 5.04, 95% CI 3.78-6.72) and 1-year mortality (OR 2.92, 95% CI 2.20-3.86), particularly when occurring after PCI.
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