Early sustained ventricular arrhythmias complicating acute myocardial infarction

OBJECTIVE: Sustained ventricular arrhythmias complicate 2% to 20% of acute myocardial infarctions (MIs) and are associated with increased in-hospital mortality. However, it remains unclear whether successful mechanical revascularization improves outcomes in these patients. The objective of this analysis was to identify predictors of sustained ventricular arrhythmias after acute MI and to determine the influence of successful revascularization on in-hospital mortality. METHODS: We conducted a retrospective cohort study of all patients who underwent percutaneous coronary intervention for acute MI in New York State between 1997 and 1999. RESULTS: Of the 9015 patients who underwent percutaneous coronary intervention for acute MI, 472 (5.2%) developed sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) before revascularization. After multivariable adjustment, independent predictors of sustained VT/VF included cardiogenic shock (odds ratio [OR], 4.10; 95% confidence interval [CI], 3.20-5.58; P < .001), heart failure (OR, 2.86; 95% CI, 2.24-3.67: P < .001), chronic kidney disease (OR, 2.58; 95% CI, 1.27-5.23; P = .009), and presentation within 6 hours of symptom onset (OR, 1.46; 95% CI, 1.18-1.81; P < .001). Patients with sustained VT/VF had greater in-hospital mortality (16.3% vs 3.7%, P < .001). Although successful percutaneous coronary intervention was associated with decreased in- hospital mortality in patients with VT/VF (P < .001), patients with sustained VT/VF and successful revascularization experienced increased mortality compared with patients without sustained ventricular arrhythmias (P < .001). CONCLUSION: Among patients undergoing percutaneous coronary intervention for acute MI, sustained VT/VF remains a significant complication associated with a 4-fold increased risk of in- hospital mortality. Early mortality is reduced after successful percutaneous coronary intervention, but remains elevated in this high-risk group. (C) 2008 Elsevier Inc. All rights reserved.