Sustained Ventricular Arrhythmias Among Patients With Acute Coronary Syndromes With No ST-Segment Elevation

Abstract

Background-The prognosis of ventricular arrhythmias among patients with non-ST-elevation acute coronary syndromes is unknown. We studied the incidence, predictors, and outcomes of sustained ventricular arrhythmias in 4 large randomized trials of such patients. .5] for VT). These differences remained significant after excluding patients with heart failure or cardiogenic shock and those who died Ͻ24 hours after enrollment. Conclusions-Despite the use of effective therapies for non-ST-elevation acute coronary syndromes, ventricular arrhythmias in this setting are associated with increased 30-day and 6-month mortality. More effective therapies are needed to improve the survival of patients with these arrhythmias. (Circulation. 2002;106:309-312.)

Incidence of, predictors for, and mortality associated with malignant ventricular arrhythmias in non-ST elevation myocardial infarction patients

“…The incidence of malignant ventricular arrhythmias was higher in our study than previously reported in patients with NSTEMI 10,11,14 . Comparison of patient characteristics reveals that NSTEMI patients in the present inner-city hospital study had a higher incidence of cardiac risk factors, including hypertension, dyslipidemia, diabetes and family history of coronary artery disease, in addition to a higher incidence of previous myocardial infarction, as compared to the patient populations in these studies 10,11,14 .…”

“…Comparison of patient characteristics reveals that NSTEMI patients in the present inner-city hospital study had a higher incidence of cardiac risk factors, including hypertension, dyslipidemia, diabetes and family history of coronary artery disease, in addition to a higher incidence of previous myocardial infarction, as compared to the patient populations in these studies 10,11,14 . In contrast, the incidence of malignant ventricular arrhythmias in the NSTEMI population studied was lower than that seen in patients with STEMI in the Global Utilization of Streptokinase and TPA for Occluded coronary arteries (GUSTO-I; 10.5%), the Global Use of Strategies to Open occluded coronary arteries (GUSTO III; 7.3%), and the Euro Heart Survey of Acute Coronary Syndromes (10%) studies 14 .…”

“…In a pooled analysis of several studies, the incidence of ventricular arrhythmias in patients with non-ST elevation acute coronary syndromes was found to be 2.1%. Several predictors were identified, including hypertension, chronic obstructive lung disease, prior MI and ST changes at presentation 11 .…”

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

“…Typical age-based ECG standards are shown in Table 1 39 and postnon-ST-elevation MI. 41 These predictors include previous hypertension, chronic obstructive pulmonary disease, previous MI, ST-segment changes at presentation, higher Killip class, and lower initial systolic blood pressure. Thus, presently, it seems reasonable to continue to monitor post-MI patients with any of these predictors beyond 48 hours until hospital discharge.…”

“…These differences present significant issues for the computerized arrhythmia detection algorithms in cardiac monitoring systems, as well as for the clinicians who interpret arrhythmias. Typical age-based ECG standards are shown in 41 These predictors include previous hypertension, chronic obstructive pulmonary disease, previous MI, ST-segment changes at presentation, higher Killip class, and lower initial systolic blood pressure. Thus, presently, it seems reasonable to continue to monitor post-MI patients with any of these predictors beyond 48 hours until hospital discharge.…”