Key result
Reperfused STEMI carries a ~3% incidence of malignant arrhythmias, with most occurring within 24 hours.
Why the study?
Despite advances in revascularization and medical therapy, routine hospital admission with at least 48 hours of continuous rhythm monitoring remains standard after AMI. This systematic review sought to define the contemporary incidence and predictors of malignant arrhythmias in reperfused AMI patients to help identify low-risk individuals who might need shorter monitoring.
Systematic Review
In reperfused AMI patients, the incidence of malignant arrhythmias remains non-negligible (1.7% to 5.2%), though 82% of events in STEMI occur within the first 24 hours, suggesting low-risk patients might safely undergo shorter rhythm monitoring durations.
Supports abbreviated monitoring for low-risk reperfused STEMI; extends timing data showing no decline since 2000.
Background Patients with acute myocardial infarction (AMI) are at risk for malignant arrhythmias (MA), defined as sustained ventricular tachycardia (VT) and ventricular fibrillation (VF). Over the past decades, advances in revascularization techniques and medical therapies have led to reduced mortality and improved outcomes following percutaneous coronary intervention. Nevertheless, the standard of care since the early 2000s has been hospital admission with continuous rhythm monitoring for at least 48 hours after an acute myocardial infarction. Taking these modern treatment strategies into account, the current incidence of MA may be lower than previously reported. Purpose This systematic review aims to describe the contemporary incidence and predictors of malignant arrhythmia in reperfused AMI patients, with the goal of identifying low-risk individuals who may benefit from shorter monitoring durations, thereby improving patient flow and reducing hospital bed occupancy. Methods Studies reporting the incidence of MA in hospitalized AMI patients (2000–2025) were identified through a systematic search, including ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). Additionally, predictors of MA were identified. Results The medians (interquartile range) of study-level reported incidences of MA across studies were 2.8% (2.4–6.4%) in STEMI patients after primary PCI (13 studies), 1.7% (0.7–2.8%) in hospitalized NSTEMI patients (10 studies), and 5.2% (4.0–8.1%) in combined hospitalized STEMI/NSTEMI cohorts (18 studies). All three groups showed considerable heterogeneity (I2≥90%). No temporal decline in MA incidence from 2000 - 2025 could be identified. Most MA (82%) in STEMI patients occurred within 24 hours of admission. Multivariate regression analyses identified Killip class II-IV (4 studies) and peak creatine kinase (3 studies) as independent predictors of MA after reperfusion. Conclusions The incidence of malignant arrhythmia in reperfused AMI patients is not negligible, especially within 24 hours. Considerable heterogeneity was demonstrated, likely due to differences in populations and the duration of in-hospital monitoring. Predictors of MA include a worse clinical condition on admission and larger infarct size. Identifying AMI patients with low risk of MA could be proposed to prevent unnecessary hospitalization.
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Kortman et al. (2026) conducted a systematic review in Acute myocardial infarction (STEMI and NSTEMI). Reperfused acute myocardial infarction (STEMI, NSTEMI, or combined) was evaluated on Incidence of malignant arrhythmias (sustained ventricular tachycardia and ventricular fibrillation). Reperfused AMI patients had median malignant arrhythmia incidences of 2.8% in STEMI, 1.7% in NSTEMI, and 5.2% in combined cohorts, with 82% of STEMI events occurring within 24 hours.
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