Early ventricular arrhythmias tied to higher mortality in STEMI patients: Study
France: Early ventricular arrhythmia (EVA) is 5-fold more common than late ventricular arrhythmia (LVA) in STEMI patients and augurs a higher risk of in-hospital all-cause mortality, reveals a recent study. Further, the researchers showed LVA to be mainly associated with the patient's baseline risk profile and surrogate markers of larger infarct size.
Vincent Auffret, University of Rennes, Rennes, France, and the team in their study published in the Archives of Cardiovascular Diseases, developed and internally validated a risk score for identifying patients at high LVA risk for whom early intensive care unit discharge may not be suitable.
Ventricular arrhythmias are one of the serious complications of ST-segment elevation myocardial infarction (STEMI) which can be life-threatening. The study was conducted with the objective to describe the incidence, predictors, and in-hospital impact of EVA (occurring < day 2 after STEMI) and LVA (occurring ≥ day 2 after STEMI) in STEMI patients.
For this purpose, the researchers analyzed data from 13,523 patients enrolled in a prospective registry. To identify predictors of EVA, LVA, and in-hospital all-cause mortality, Logistic and Cox regressions were performed. Predictors of LVA were used to build a risk score.
Following were the study's salient findings:
- EVA occurred in 678 patients (5%), whereas 120 patients (0.9%) experienced LVA, at a median timing of 3 days after STEMI.
- EVA was associated with a significantly higher risk of all-cause mortality (hazard ratio: 1.44), whereas no association was observed with LVA (hazard ratio 0.86). Multivariable predictors of LVA were: age ≥ 65 years; serum creatinine ≥ 85 μmol/L on admission; pulse pressure ≤ 45 mmHg on admission; presence of a Q wave on admission electrocardiogram; Thrombolysis In Myocardial Infarction flow grade < 3 after percutaneous coronary intervention; and left ventricular ejection fraction ≤ 45%.
- The score derived from these variables allowed the classification of patients into four risk categories: low (0–21); low-to-intermediate (22–34); intermediate-to-high (35–44); and high (≥ 45).
- Observed LVA rates were 0.2%, 0.3%, 0.9% and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow).
To conclude, EVA is 5-fold more common than LVA in the setting of STEMI, and portends a higher risk of in-hospital all-cause mortality.
Reference:
The study titled, "Early and late ventricular arrhythmias complicating ST-segment elevation myocardial infarction," was published on the journal Archives of Cardiovascular Diseases.
