Impact of Late Ventricular Arrhythmias on Cardiac Mortality in Patients with Acute Myocardial Infarction

Abstract

Objectives. This study investigated the relationship between the timing of ventricular tachycardia or ventricular fibrillation (VT or VF) and prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Background. It is unknown whether the timing of VT/VF occurrence affects the prognosis of patients with AMI. Methods. From January 2004 to December 2014, 1004 patients with AMI underwent primary PCI. Of these patients, 888 did not have VT/VF (non-VT/VF group) and 116 had sustained VT/VF during prehospitalization or hospitalization. Patients with VT/VF were divided into two groups: early VT/VF (VT/VF occurrence before and within 2 days of admission, 92 patients) and late VT/VF (VT/VF occurrence >2 days after admission; 24 patients) groups. Results. The frequency of VT/VF occurrence was high between the day of admission and the 2nd day and between days 6 and 10 of hospitalization. The late VT/VF group had a significantly longer onset-to-balloon time, lower ejection fraction, poorer renal function, and higher creatine phosphokinase (CK)-MB level on admission (p< 0.001). They also had a lower 30-day cardiac survival rate than the early VT/VF and non-VT/VF groups (42% vs. 76% vs. 96%, p < 0.001). Moreover, independent predictors of in-hospital cardiac mortality among patients with AMI who had sustained VT/VF were higher peak CK-MB [Odds ratio (OR: 1.001, 95%confidence interval (CI): 1.000-1.002, p= 0.03)], higher Killip class (OR: 1.484, 95%CI 1.017-2.165, p= 0.04), and late VT/VF (OR: 3.436, 95%CI 1.115-10.59, p= 0.03). Conclusions. The timing of VT/VF occurrences had a bimodal peak. Although late VT/VF occurrence after primary PCI was less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis.

Early or First Aid Administration Versus Late or In-hospital Administration of Aspirin for Non-traumatic Adult Chest Pain: A Systematic Review

“…In one study, the cohort receiving early aspirin suffered more in-hospital arrhythmias, however, this complication did not affect the overall survival of this cohort [9]. Reasons for conflicting results regarding arrhythmias and survival might relate to the time point of the ventricular arrhythmias since those occurring early in the time course of the clinical event come with a higher incidence of survival than with late arrhythmias [10][11].…”

In-Hospital Mortality Risk Factor Analysis in Multivessel Percutaneous Coronary Intervention Inpatient Recipients in the United States

“…Global reperfusion would help in alleviating any future infarction due to the instability of the lesion. But it is a double-edged sword as it depends on many factors like onset to balloon time, levels of b-type natriuretic peptide, sympathetic tone, elevated lactate/phosphate levels, and many more factors [ 25 ]. This again suggests that it is an interplay, and hence reperfusion cannot be a standalone factor for mortality [ 26 ].…”

Arrhythmia in Acute Myocardial Infarction: A Six-Month Retrospective Analysis From the National Institute of Cardiovascular Diseases

“…Historically, AMI with VT has been associated with abysmal mortality rates, with rates exceeding 60% at 30 days post-infarction [ 30 ]. Male sex, hyperglycemia, and delays in the intervention are further associated with reduced survival in AMI with VT [ 30 ].…”

“…Historically, AMI with VT has been associated with abysmal mortality rates, with rates exceeding 60% at 30 days post-infarction [ 30 ]. Male sex, hyperglycemia, and delays in the intervention are further associated with reduced survival in AMI with VT [ 30 ]. Even though VT was the least frequent arrhythmia observed in our study, it still caused the second-highest overall mortality and the highest in-group mortality; two-thirds of the patients with VT died while still at the hospital.…”