Incidence and predictors of ventricular arrhythmias after ST-segment elevation myocardial infarction

Ohlow, Marc‐Alexander; Geller, J. Christoph; Richter, Stefan; Farah, Ahmed; Müller, Stefan; Fuhrmann, Jörg; Lauer, Bernward

doi:10.1016/j.ajem.2011.02.029

Cited by 28 publications

(34 citation statements)

References 37 publications

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“…The optimal duration for monitoring arrhythmias after PPCI has not been determined. A recent study 22 showed that arrhythmias can be present up to 48 hours after PPCI but Mehta and colleagues 23 reported results from the HORIZONS-AMI trial confirming that these late arrhythmias were not associated with morbidity or mortality. Our data supports monitoring for 24 hours in low-risk patients after PPCI.…”

Section: Discussionmentioning

confidence: 99%

Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction

Noman

Zaman

Schechter

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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Background: To assess safety of early discharge following primary percutaneous coronary intervention (PPCI) for STelevation myocardial infarction (STEMI). Methods and results: Retrospective analysis of prospectively collected data of 2448 STEMI patients treated with PPCI surviving to hospital discharge. Post-discharge all-cause mortality was reported at 1, 7, and 30 days and long-term follow up. A total of 1542 patients (63.0%) were discharged within 2 days of admission (early discharge group) and 906 patients (37.0%) after 2 days (late discharge group). In both groups, no deaths were recorded 1 day post discharge. The early and late discharge group mortality figures for 7 days were 0 and 4 patients (0.04%) and between 7 and 30 days were 11 (0.7%) and 11 patients (1.2%), respectively. During a mean follow up of 584 days, 178 patients (7.3%) died: 67 in the early discharge group (4.3%) and 111 in the late discharge group (12.3%). Conclusions: This exploratory, observational study demonstrates that discharging low-risk STEMI patients within 2 days following PPCI is safe. For providers of health care, early discharge can help to allay the cost of providing a 24-hour PPCI service and adds to the recognized benefits arising from PPCI.

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Section: Discussionmentioning

confidence: 99%

Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction

Noman

Zaman

Schechter

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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“…158 In patients with STEMI undergoing primary PCI, the incidence of malignant ventricular arrhythmias is ≈5% (4.7%-5.7%), with 60% to 64% of ventricular arrhythmias occurring within the first 24 hours of ad mission and 90% to 92% occurring within 48 hours of PCI. 128,159 Rahimi et al 160 reported a lower incidence of malignant ventricular arrhythmias in a sample of pa tients with NSTEMI undergoing PCI (2.6%), with 80% occurring during the first 12 hours and none after 48 hours. The overall incidence of ventricular arrhythmias in patients with acute MI undergoing PCI has been re ported as 2.6% to 5.7 %.…”

Section: After MI With Revascularizationmentioning

confidence: 99%

“…Factors including prior MI/Q waves on admission, previous heart failure, brain natriuretic peptide >80 pg/mL, use of diuretics/hypokalemia, heart rate >100 bpm, left ventricular ejection fraction <40%, lower systolic blood pressure, chronic kidney disease/elevated creatinine, chronic obstructive pulmo nary disease (COPD), elevated white blood cell count, older age, and higher Killip class were associated with mortality. 157,159,160,163 There is disagreement about the need to continue electrocardiographic monitoring of patients with ACS beyond 24 to 48 hours. Although several studies have found that ventricular arrhythmias occur infrequently beyond 48 hours after MI, 159,160 data in this setting are conflicting.…”

Section: After MI Without Reperfusion or Revascularizationmentioning

confidence: 99%

“…The overall incidence of ventricular arrhythmias in patients with acute MI undergoing PCI has been re ported as 2.6% to 5.7 %. 127,128,159,160 Because the major ity occur within 12 to 48 hours after presentation with STEMI or NSTEMIACS, arrhythmia monitoring should be initiated immediately on presentation and contin ue uninterrupted for 12 to 24 hours after reperfusion therapy (PCI or thrombolytic therapy), including during transportation within the hospital. The appropriateness of early discharge versus continued monitoring needs…”

Section: After MI With Revascularizationmentioning

confidence: 99%

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Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

206

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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“…Moreover, the only factor associated with the occurrence of malignant ventricular arrhythmia was higher white blood cell count on admission [19]. A similar study of 510 patients who underwent PCI for STEMI indicated that 60% of sustained ventricular arrhythmia occurred during the first 24 h, and 92% during the first 48 h. Independent predictors of sustained ventricular arrhythmia included higher white blood cell count, lower hematocrit and lack of beta-blocker medication [20,21]. Overall, the occurrence of ventricular arrhythmias after AMI was not easy to predict.…”

Section: How To Identify Eligible Patients?mentioning

confidence: 91%

Early Intravenous Beta-blockers for Acute Myocardial Infarction

Guo¹,

He²,

Fu³

2017

J Clin Exp Cardiolog

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Early intravenous beta-blockers reduce the risk of recurrent ischaemia and ventricular arrhythmia in the treatment of acute myocardial infarction. These beneficial efficacy, however, are balanced by a high rate of cardiogenic shock. It has great significance for reliable identification of subgroups of patients among whom treatment is really advantageous. The present article is a review on the efficacy and safety of the early intravenous beta-blockers, and provides an evaluation procedure to guide clinicians applying intravenous beta-blockers to clinical practice.Keywords Beta-blockers; Acute myocardial infarction ReviewBeta-blockers are heralded as a major advance in the treatment of patients with myocardial infarction (MI). Patients without contraindications are recommended to receive intravenous administration of beta-blockers at the time of presentation for relief of ischemic pain; for the control of hypertension, sinus tachycardia and sustained ventricular tachycardia; and for the primary prevention of sudden cardiac death (Class I, Level of Evidence B) [1]. Recent data have called into question the role of beta-blockers in MI. Recommendations on the intravenous administration of beta-blockers by current guidelines are more prudent in these cases (Class IIa, Level of Evidence B) [2,3]. The use of early β-blocker therapy for patients with AMI in China is suboptimal, with underuse in patients who could benefit and substantial use among those who might be harmed [4]. The present article is a review on the efficacy and safeties of the early administration of intravenous beta-blockers examined in trials conducted in the pre-reperfusion era and reperfusion era, and provide an evaluation procedure to guide clinicians applying IV beta-blockers to clinical practice. DeathTwo large trials were conducted in the pre-reperfusion era. In the Metoprolol in Myocardial Infarction (MIAMI) trial, intravenous metoprolol followed by oral administration did not significantly reduce 15-day mortality (4.3% vs. 4.9%, P=0.29) as compared to placebo [5].In another large randomized study, the First International Study of Infarct Survival (ISIS-1) trial, there was significantly lower vascular mortality during the first seven days in the atenolol group (3.89% vs.4.57% , P<0.04) as compared to the placebo group [6]. A meta-analysis of 51 early trials of intravenous beta-blockers, administered at the time of presentation in the pre-reperfusion era, revealed a small and nonsignificant reduction in mortality. The number needed to treat (NNT) was 250 patients to avoid one death [7].Similarly, two large trials were conducted in the reperfusion era. In the Thrombolysis in Myocardial Infarction (TIMI) Phase IIB study, there was no difference in mortality neither within 6 days of entry (2.4% vs. 2.4%, P=0.98) nor within 6 weeks of entry (3.6% vs. 3.5%, P=0.91) between the immediate metoprolol intravenous and deferred groups [8]. The ClOpidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) were to assess the balance of risks and ...

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Incidence and predictors of ventricular arrhythmias after ST-segment elevation myocardial infarction

Cited by 28 publications

References 37 publications

Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction

Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Early Intravenous Beta-blockers for Acute Myocardial Infarction

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