Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: A substudy of VALIDATE-SWEDEHEART trial

Marina M Demidova; Rebecca Rylance; Sasha Koul; Christian Dworeck; Stefan James; Mikael Aasa; Mehmet Hamid; Eva Swahn; Kristina Hambraeus; Mikael Danielewicz; Rikard Linder; Ole Fröbert; Per Grimfjärd; Jason Stewart; Loghman Henareh; Jonas Andersson; Henrik Wagner; David Erlinge; Pyotr G Platonov

doi:10.1016/j.hroo.2022.12.008

Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: A substudy of VALIDATE-SWEDEHEART trial

Heart Rhythm O2. 2022 Dec 22;4(3):200-206. doi: 10.1016/j.hroo.2022.12.008. eCollection 2023 Mar.

Authors

Marina M Demidova¹, Rebecca Rylance¹, Sasha Koul¹, Christian Dworeck², Stefan James³, Mikael Aasa⁴, Mehmet Hamid⁵, Eva Swahn⁶, Kristina Hambraeus⁷, Mikael Danielewicz⁸, Rikard Linder⁹, Ole Fröbert¹⁰, Per Grimfjärd¹¹, Jason Stewart¹², Loghman Henareh¹³, Jonas Andersson¹⁴, Henrik Wagner¹⁵, David Erlinge¹, Pyotr G Platonov¹

Affiliations

¹ Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
² Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
³ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁴ Department of Cardiology, Södersjukhuset, Stockholm, Sweden.
⁵ Department of Cardiology, Mälarsjukhuset, Eskilstuna, Sweden.
⁶ Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
⁷ Department of Cardiology, Falun Hospital, Falun, Sweden.
⁸ PCI-Unit, Karlstad Hospital, Karlstad, Sweden.
⁹ Department of Cardiology, Danderyd Hospital, Stockholm, Sweden.
¹⁰ Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
¹¹ Department of Internal Medicine, Västmanlands Hospital, Västerås, Sweden.
¹² Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden.
¹³ Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
¹⁴ Department of Cardiology, Umeå University, Umeå, Sweden.
¹⁵ Department of Cardiology, Helsingborg Hospital, Helsingborg, Sweden.

Abstract

Background: Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (<48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia.

Objective: We analyzed the prognostic value of early ventricular arrhythmias (VAs) in STEMI with regard to their type and timing.

Methods: The prespecified analysis of the multicenter prospective Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarctionin Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease evaluated according to Recommended Therapies Registry Trial included 2886 STEMI patients undergoing primary percutaneous coronary intervention (PCI). VA episodes were characterized regarding their type and timing. Survival status at 180 days was assessed through the population registry.

Results: Nonmonomorphic VT or VF was observed in 97 (3.4%) and monomorphic VT in 16 (0.5%) patients. Only 3 (2.7%) early VA episodes occurred after 24 hours from symptom onset. VA was associated with higher risk of death (hazard ratio 3.59; 95% confidence interval [CI] 2.01-6.42) after adjustment for age, sex, and STEMI localization. VA after PCI was associated with an increased mortality compared with VA before PCI (hazard ratio 6.68; 95% CI 2.90-15.41). Early VA was associated with in-hospital mortality (odds ratio 7.39; 95% CI 3.68-14.83) but not with long-term prognosis in patients discharged alive. The type of VA was not associated with mortality.

Conclusion: VA after PCI was associated with an increased mortality compared with VA before PCI. Long-term prognosis did not differ between patients with monomorphic VT and nonmonomorphic VT or VF, but events were few. VA incidence during 24 to 48 hours of STEMI is negligibly low, thus precluding assessment of its prognostic importance.

Keywords: Monomorphic ventricular tachycardia; PCI; STEMI; Ventricular arrhythmias; Ventricular fibrillation.