Ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention and their prognostic value

Abstract

Reperfusion therapy in myocardial infarction patients with acute ST-segment elevation significantly reduced the frequency of ventricular tachycardia and ventricular fibrillation, however, such arrhythmias still occur in 6-8% of patients, posing a threat to their lives.The aim of the study was to determine the nature of ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention, and their prognostic value regarding the development of complications during the inpatient treatment phase. The study involved 82 individuals (mean age: 62,4±10,2 years; male: 69,23 (58,6-78,92)%, female: 30,77 (21,08-41,4)%). Within 24 hours after the infarct-related artery stenting, all patients underwent a 24-hour Holter ECG monitoring. The course of the disease was analyzed based on the presence of risk factors such as hypertension, diabetes mellitus, past COVID-19, and obesity. Ventricular rhythm disturbances were represented mainly by premature contractions. They occurred significantly more frequently in patients with arterial hypertension (883,71 (96,0; 986.0); p=0,02; p=0,03; p=0,02, compared to patients with a history of COVID-19, diabetes, and obesity, respectively) and in those with past COVID-19 (711,3 (125,0; 846,5); p=0,01; p=0,04, compared to indi­viduals with diabetes and obesity, respectively). Isolated premature ventricular complexes, pairs, triplets were recorded, and in individuals with arterial hypertension and past COVID-19 “runs” of ventricular extrasystoles and episodes of nonsustained monomorphic and even polymorphic ventricular tachycardia, such as Torsades de Pointes, (under the condition of combined risk factors) were noted; predominantly in these patients during the hospital phase such сom­plications as ventricular fibrillation and asystole,with sudden cardiac arrest developed. The obtained results is an evidence of electrical myocardial instability and indicate that myocardial infarction patients with acute ST-segment elevation, in addition to myocardial revascularization, require optimization of pharmacological treatment. The use of intravenous beta-blockers as part of complex treatment prevented the occurrence of life-threatening ventricular arrhythmias during the inpatient treatment phase.