Introduction:
Stable patients with STEMI and successful reperfusion may be considered for early discharge; however, little is known about the incidence of late ventricular tachycardia or fibrillation (VT/VF occurring at least 1 day after PCI) that may warrant further monitoring.
Methods:
We identified 162,822 STEMI patients treated with primary PCI and without VT/VF on the day of PCI in the NCDR Chest Pain-MI Registry from January 2015-December 2018. A low risk subgroup (n=96,188) was identified by excluding patients with prior MI, heart failure, systolic BP<90 mmHg, cardiogenic shock, cardiac arrest, re-infarction on the day of PCI, or ejection fraction<40%. The incidence and timing of VT/VF (any VT≥7 beats or VF) was determined in the overall and low risk cohorts. The association between late VT/VF and in-hospital mortality was evaluated using multivariable logistic regression.
Results:
Late VT/VF occurred in 2.6% of patients overall and 1.8% in the low risk cohort. In patients with late VT/VF, cardiac arrest occurred in 20.3% and 7.7% of the overall and low risk cohorts, respectively. Many late VT/VF events (37.0% overall, 24.4% low risk cohort) occurred ≥2 days after PCI. Patients with late VT/VF were older, more likely to be men, and have prior cardiovascular disease or risk factors than patients without VT/VF; they also had higher rates of post-PCI heart failure, cardiogenic shock, cardiac arrest, and stroke (
Figure
). The risk of death was higher for patients with vs. without VT/VF in both the overall (15.4% vs. 2.4%, adjusted OR [aOR] 6.40, 95% CI 5.63-7.29) and low risk cohorts (3.7% vs. 0.5%, aOR 8.74, 95% CI 6.53-11.70).
Conclusions:
Late VT/VF after STEMI was infrequent but often occurred ≥2 days post-PCI and was associated with an increased risk of death, even in the low risk cohort. Novel ways to monitor and rapidly treat late VT/VF may avoid prolonged hospitalization after STEMI.
Ventricular Arrhythmias Underlie Sudden Death in Rats With Heart Failure and Preserved Ejection Fraction
