Relation of Early Monomorphic Ventricular Tachycardia to Long-Term Mortality in ST-Elevation Myocardial Infarction

Abstract Background The assessment of prognostic impact of ventricular arrhythmias in ST-elevation myocardial infarction (STEMI) is currently based mainly on their timing with regard to the symptom onset and does not distinguish between monomorphic ventricular tachycardia (VT) and polymorphic VT/ventricular fibrillation (VF). However, recent data indicate long-term hazard of monomorphic VT occurring early in the course of STEMI. Purpose To evaluate the incidence, time distribution and prognostic value of early monomorphic VT compared to polymorphic VT/VF in STEMI patients treated by primary percutaneous coronary interventions (PCI). Methods A prespecified analysis of the multicentre prospective registry-based randomised VALIDATE-SWEDEHEART trial included STEMI patients enrolled at 16 sites in Sweden between June 2014 and September 2016. Source data verification regarding the type and timing of arrhythmia from all patients with VT/VF during STEMI was performed. Survival status was obtained from the Swedish national population registry. Endpoint was total mortality at 180 days. Results In total, 2886 patients were identified. Among them, 97 (3.4%) had VF or polymorphic VT, 16 (0.5%) monomorphic VT, 6 (0.2%) had other undefined shockable rhythm. Total mortality (10.9% vs 2.8%, p≤0.001) was higher among patients with VT/VF. VT/VF was associated with total mortality (HR 3.18 95% CI 1.74–5.8; p≤0.001) after adjustment on age, gender and myocardial infarction localisation. In patients discharged from hospital, VT/VF did not influence the long-term prognosis. Patients with monomorphic VT had similar clinical characteristics as compared to those with polymorphic VT/VF. The time distribution of VT/VF differed with regard to the type of arrhythmia: 63% of monomorphic VT/VF episodes occurred after PCI (n=10) compared to 24% (n=23) of all documented polymorphic VT/VF, p=0.003. Total mortality (12.5% vs 10.3%, p=0.678) did not differ between patients with monomorphic VT and polymorphic VT/VF. In Cox model, total mortality was not associated with the type of arrhythmia (Figure). Conclusion Early VT/VF is a marker of poor short-term outcome in patients with STEMI, which does not affect long-term prognosis in those who are successfully resuscitated and discharged from hospital. The incidence of monomorphic VT in STEMI treated by primary PCI is low, and it occurs mainly after PCI. Though no significant difference in mortality was found between patients with monomorphic VT and polymorphic VT/VF, the observed low incidence hampers drawing conclusions with regard to the prognostic hazard impact of monomorphic VT. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Swedish Heart Lung Foundation

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Borderline trend towards long-term mortality benefit from drug eluting stents implantation in ST-elevation myocardial infarction patients in Poland-data from NRDES registry

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.25169 ◽

2013 ◽

Vol 83 (3) ◽

pp. 436-442 ◽

Cited By ~ 3

Author(s):

Zbigniew Siudak ◽

Artur Dziewierz ◽

Tomasz Rakowski ◽

Krzysztof Żmudka ◽

Jacek Legutko ◽

...

Keyword(s):

Myocardial Infarction ◽

St Elevation Myocardial Infarction ◽

Drug Eluting Stents ◽

Mortality Benefit ◽

Drug Eluting ◽

St Elevation ◽

Long Term Mortality

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Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery

Journal of International Medical Research ◽

10.1177/0300060521992995 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199299

Author(s):

Wenlan Hu ◽

Kaiping Zhao ◽

Youzhou Chen ◽

Jihong Wang ◽

Mei Zheng ◽

...

Keyword(s):

Myocardial Infarction ◽

Orthopaedic Surgery ◽

Troponin I ◽

Cox Regression ◽

St Elevation Myocardial Infarction ◽

Entire Cohort ◽

St Elevation ◽

Universal Definition ◽

Long Term Mortality

Objective To investigate the clinical characteristics and long-term mortality of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic surgery. Methods This retrospective, single-centre study enrolled patients that underwent inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan Hospital. The patients were screened for a cardiac troponin I elevation and fulfilled the Fourth Universal Definition of Myocardial Infarction within 30 days of surgery. Results A total of 180 patients that developed perioperative myocardial infarction (MI) were included in the study. Among them, 14 patients (7.8%) were classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with NSTEMI, STEMI patients had significantly higher 30-day and long-term mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively). Multivariate Cox regression model analysis among the entire cohort demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval [CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most significant independent predictors of long-term mortality. Conclusion Perioperative MI after orthopaedic surgery was associated with a high mortality rate. STEMI was independently associated with a significant increase in short- and long-term mortality.

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Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network

Wiener klinische Wochenschrift ◽

10.1007/s00508-017-1250-7 ◽

2017 ◽

Vol 130 (5-6) ◽

pp. 172-181 ◽

Cited By ~ 4

Author(s):

Paul Michael Haller ◽

Bernhard Jäger ◽

Serdar Farhan ◽

Günter Christ ◽

Wolfgang Schreiber ◽

...

Keyword(s):

Myocardial Infarction ◽

St Elevation Myocardial Infarction ◽

Short And Long Term ◽

St Elevation ◽

Long Term Mortality

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The effect of serum potassium level on in-hospital and long-term mortality in ST elevation myocardial infarction

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.07.024 ◽

2016 ◽

Vol 221 ◽

pp. 505-510 ◽

Cited By ~ 14

Author(s):

Muhammed Keskin ◽

Adnan Kaya ◽

Mustafa Adem Tatlısu ◽

Mert İlker Hayıroğlu ◽

Osman Uzman ◽

...

Keyword(s):

Myocardial Infarction ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Long Term Mortality

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Abstract 13193: Impact of “Off-Peak” Versus “Peak” Hour Coronary Interventions for ST-Elevation Myocardial Infarction on Adverse Outcomes

Circulation ◽

10.1161/circ.132.suppl_3.13193 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jae S Lee ◽

Gabriel Redel-Traub ◽

Michael Kim ◽

Perwaiz Meraj ◽

Christina Brennan ◽

...

Keyword(s):

Myocardial Infarction ◽

Propensity Score ◽

Adverse Outcomes ◽

St Elevation Myocardial Infarction ◽

Coronary Interventions ◽

St Elevation ◽

Peak Versus ◽

Versus Peak ◽

Long Term Mortality

Background: In addition to patient-dependent factors, whether the time of arrival of the patient to the hospital with ST-elevation myocardial infarction (STEMI) might play a role in subsequent adverse outcomes following primary percutaneous coronary interventions (PCI) is not well studied. Method: 856 PCI procedures for patients presenting with STEMI from two large hospitals in the health system were analyzed. Peak hours were defined as procedures performed between 7 AM and 7 PM on weekdays. Off-peak hours were defined as procedures performed between 7 PM and 7 PM on weekdays and weekends. Unadjusted and propensity score-adjusted analyses were performed to analyze the following inpatient outcomes: composite of death/MI/stroke, composite of bleeding events, composite of death/MI/stroke/bleeding endpoints, and long-term mortality. Results: Of 856 PCIs, 407 (47.5%) were performed during the peak hours. In both unadjusted and propensity score-adjusted analyses, no significant differences in adverse outcomes and long-term mortality were observed in patients who had PCIs during off-peak and peak hours (see Table). In addition, a separate analysis performed on patients who underwent primary PCIs between 7 AM-7 PM (“Morning”) versus 7 PM-7 AM (“Evening”) on all days showed no difference in the inpatient adverse outcomes and long-term mortality (Adjusted long term mortality: HR 0.79 (95% CI 0.40-1.56), p=0.49). Conclusion: Primary PCIs performed on patients presenting with STEMI during off-peak versus peak hours results in similar inpatient adverse outcomes and long-term mortality.

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Abstract 108: Contemporary Timing and Etiology of Mortality in ST-Elevation Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.108 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Zachary J Il'Giovine ◽

Anirudh Kumar ◽

Chetan Huded ◽

Venu Menon ◽

Amar Krishnaswamy ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Discharge ◽

Systems Of Care ◽

Significant Risk ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Early Reperfusion ◽

St Elevation ◽

Long Term Mortality

Background: Acute treatment of ST-elevation myocardial infarction (STEMI) has focused on early reperfusion, prompt defibrillation, and appropriate mechanical support to mitigate short-term mortality. Long-term patterns of death in a contemporary population are not well described. Methods: We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011, and December 31, 2016, and divided patients into two groups: uncomplicated STEMI (US) and complicated STEMI (CS). CS was defined by presence of cardiac arrest or cardiogenic shock, ascertained from first-medical-contact to device time for PCI. We assessed for differences in characteristics and short- and long-term mortality between the groups. Results: We identified 1,272 patients with STEMI; 214 of which were CS (16.8%). Those with CS were significantly more likely to have heart failure (22.9% vs 11.3%, p<0.001), kidney disease (38.2% vs. 21.0%, p<0.001), cerebrovascular disease (18.7% vs 11.0%, p=0.003), peripheral vascular disease (16.8% vs 7.9%, p<0.001), and left main or left anterior descending culprit vessel (51.9% vs. 40.3%, p<0.002). Total in-hospital mortality was 5.0% (63 patients), with 19.6% (42/214) and 2.0% (21/1058) of those with CS and US respectively (p<0.001). Among 1209 of patients that survived to hospital discharge, total long-term mortality was 10% (121 patients) of which 18.0% (31/172) had CS and 8.7% (90/1037) had US (p=0.001) over mean follow-up of 3.1±1.9 years. Of those, 52% and 50%, respectively, were from non-cardiovascular etiologies (Figure) including malignancy (13% vs. 22%), infection (22% vs. 19%), or other causes (17% vs. 9.0%). Conclusion: Despite advances in the in-hospital care of patients with STEMI, there remains a significant risk of long-term mortality for both patients with uncomplicated and complicated STEMI. A substantial proportion of overall STEMI mortality now occurs after hospital discharge predominantly due to non-cardiovascular causes. Systems of care to mitigate this long-term risk are needed.

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