The Relationship Between Primary Ventricular Arrhythmias and In-hospital Mortality and Resuscitated Cardiopulmonary Arrest in Patients with Acute ST Segment Elevation Myocardial Infarction

Yıl 2024, Cilt: 14 Sayı: 2, 183 - 189, 29.08.2024

Evliya Akdeniz , Barış Şimşek Veysel Ozan Tanık , Mehmet Saygı , Levent Pay , Kemal Emrecan Parsova , Furkan Durak , Ahmet Çağdaş Yumurtaş , Osman Uzman , Duygu İnan , Duygu Genç Can Yücel Karabay

Öz

Aim: Arrhythmic complications in patients with acute coronary syndromes during hospitalization are not uncommon in cardiology practice. In our retrospective study, we investigated the effect of primary ventricular arrhythmias occurring within the first 48 hours from the time of hospitalization on cardiovascular mortality and resuscitated cardiopulmonary arrest in patients with ST-segment elevation myocardial infarction. Introduction: Although the rate of myocardial infarction has decreased over the years, it is responsible for hundreds of thousands of deaths worldwide. Arrhythmic complications take an essential place for morbidity and mortality in the course of myocardial infarction. Ventricular arrhythmias play a pivotal role in terms of mortality in acute terms of myocardial infarction.
Material and Method: In our single center and retrospective study, 18-year-old and older patients who presented to Sağlik Bilimleri University Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital emergency department with ischemic symptoms and were admitted to hospital with the diagnose of ST-segment elevation myocardial infarction were enrolled. The primary endpoint was in-hospital mortality and resuscitated cardiopulmonary arrest.
Results: 1,137 patients were included in the study. Primary VT/VF which occurred within the first 48 hours from the time of hospitalization was observed in 8.2% of patients (n: 93). Previous MI history (3.47 OR, 95% CI 1.41–8.55 p=0.0068, LASSO: 0.388), KILLIP class at the time of admission (1.52 OR, 95% CI 0.94–2.45 p=0.0813, LASSO: 0.627), Primary VT/VF (4.02 OR, 95% CI 1.44–11.21 p=0.0077, LASSO: 0.440), left ventricle ejection fraction calculated by transthoracic echocardiography (0.88 OR, 95% CI 0.78–0.99 p=0.0444, LASSO: -0.032) and serum CRP level (1.81 OR, 95% CI 0.22–14.53 p=0.57, LASSO: 0.036) were independent predictors of MACE including in-hospital mortality and resuscitated cardiopulmonary arrest.
Conclusion: Primary VT and VF are independent predictors of inhospital mortality and resuscitated cardiopulmonary arrest events in patients with ST-segment elevation acute MI.

Anahtar Kelimeler

myocardial infarction, STEMI, ventricular arrhythmias, in-hospital mortality

Kaynakça

• 1. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS -population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362(23):2155–65.
• 2. Mehta RH, Starr AZ, Lopes RD, Hochman JS, Widimsky P, Pieper KS, et al. Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention. JAMA. 2009;301(17):1779–89.
• 3. Piccini JP, Berger JS, Brown DL. Early sustained ventricular arrhythmias complicating acute myocardial infarction. Am J Med. 2008;121(9):797–804.
• 4. Tran HV, Ash AS, Gore JM, Darling CE, Kiefe CI, Goldberg RJ. Twenty-five-year trends (1986–2011) in hospital incidence and case-fatality rates of ventricular tachycardia and ventricular f ibrillation complicating acute myocardial infarction. Am Heart J. 2019;208:1–10.
• 5. Henkel DM, Witt BJ, Gersh BJ, Jacobsen SJ, Weston SA, Meverden RA, et al. Ventricular arrhythmias after acute myocardial infarction: a 20-year community study. Am Heart J. 2006;151(4):806–12.
• 6. Vallabhajosyula S, Patlolla SH, Verghese D, Ya’Qoub L, Kumar V, Subramaniam AV, et al. Burden of Arrhythmias in Acute Myocardial Infarction Complicated by Cardiogenic Shock. Am J Cardiol. 2020;125(12):1774–81.
• 7. Kosmidou I, Embacher M, McAndrew T, Dizon JM, Mehran R, Ben-Yehuda O, et al. Early Ventricular Tachycardia or Fibrillation in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention and Impact on Mortality and Stent Thrombosis (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial) . Am J Cardiol. 2017;120(10):1755–60.
• 8. Al-Khatib SM, Stebbins AL, Califf RM, Lee KL, Granger CB, White HD, et al. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J. 2003;145(3):515–21.
• 9. Ohlow MA, Geller JC, Richter S, Farah A, Müller S, Fuhrmann JT, et al. Incidence and predictors of ventricular arrhythmias after ST-segment elevation myocardial infarction. Am J Emerg Med. 2012;30(4):580–86.
• 10. Mehta RH, Harjai KJ, Grines L, Stone GW, Boura J, Cox D, et al. Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention: incidence, predictors, and outcomes. J Am Coll Cardiol. 2004;43(10):1765–72.
• 11. García-García C, Oliveras T, Rueda F, Pérez-Fernández S, Ferrer M, et al. Primary Ventricular Fibrillation in the Primary Percutaneous Coronary Intervention ST-Segment Elevation Myocardial Infarction Era (from the “Codi IAM” Multicenter Registry) . Am J Cardiol. 2018;122(4):529–36.
• 12. Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm. 2020;17(1):e2–e154.
• 13. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension [published correction appears in Eur Heart J. 2019;40(5):475]. Eur Heart J. 2018;39(33):3021–104.
• 14. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021 [published correction appears in Diabetes Care. 2021;44(9):2182]. Diabetes Care. 2021;44(Suppl 1):S15–33.
• 15. Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two-year experience with 250 patients. Am J Cardiol. 1967;20(4):457–64.
• 16. Volpi A, Cavalli A, Santoro L, Negri E. Incidence and prognosis of early primary ventricular fibrillation in acute myocardial infarction--results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-2) database. Am J Cardiol. 1998;82(3):265–71.
• 17. Newby KH, Thompson T, Stebbins A, Topol EJ, Califf RM, Natale A. Sustained ventricular arrhythmias in patients receiving thrombolytic therapy: incidence and outcomes. The GUSTO Investigators. Circulation. 1998;98(23):2567–73.
• 18. Jabbari R, Risgaard B, Fosbøl EL, Scheike T, Philbert BT, Winkel BG, et al. Factors Associated With and Outcomes After Ventricular Fibrillation Before and During Primary Angioplasty in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2015;116(5):678–85.
• 19. Bhar-Amato J, Davies W, Agarwal S. Ventricular Arrhythmia after Acute Myocardial Infarction:‘The Perfect Storm.’ Arrhythm Electrophysiol Rev. 2017;6(3):134–9.
• 20. Di Diego JM, Antzelevitch C. Ischemic ventricular arrhythmias: experimental models and their clinical relevance. Heart Rhythm. 2011;8(12):1963–68.
• 21. Sasano T, Abraham MR, Chang KC, Ashikaga H, Mills KJ, Holt DP, et al. Abnormal sympathetic innervation of viable myocardium and the substrate of ventricular tachycardia after myocardial infarction. J Am Coll Cardiol. 2008;51(23):2266–75.
• 22. Li CY, Li YG. Cardiac sympathetic nerve sprouting and susceptibility to ventricular arrhythmias after myocardial infarction. Cardiol Res Pract. 2015;2015:698368.