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Identifying patients at low risk of death from cardiac failure after operation for postinfarct ventricular
J P Bourke1, J Gray, C J Hilton
1Freeman Hospital and Department of Medical Statistics, University of Newcastle upon Tyne, United Kingdom.
Insights
Identifying patients at low risk of death after antiarrhythmic operation for ventricular tachycardia (VT) is crucial. This study found specific predictors, allowing for prospective risk stratification and optimized treatment strategies in the implantable cardioverter-defibrillator era.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Cardiac failure is the leading cause of death post-antiarrhythmic operation for postinfarction ventricular tachycardia (VT).
- Predicting low-risk patients is essential for optimizing treatment strategies.
Purpose of the Study:
- To identify predictors of low risk for cardiac failure deaths after antiarrhythmic operation for VT.
- To enable prospective risk stratification of patients undergoing antiarrhythmic operation.
Main Methods:
- Retrospective analysis of 100 consecutive patients undergoing antiarrhythmic operation for VT.
- Evaluation of 13 pre-selected variables for predictive value.
- Multivariate analysis to identify significant predictors and low-risk groups.
Main Results:
- Emergency antiarrhythmic operation, wall motion score < 3, and Killip classification were significantly associated with cardiac failure deaths.
- A specific low-risk group for death was identified with 95% specificity.
- Need for emergency operation correlated with ventricular dysfunction.
Conclusions:
- Patients at low risk of death after antiarrhythmic operation can be prospectively identified.
- Elective antiarrhythmic operation should be reserved for identified low-risk patients in the implantable cardioverter-defibrillator era.
- Emergency antiarrhythmic operation may be justified in select younger patients without comorbidities.
Background:
In unselected patients, cardiac failure accounted for most deaths after antiarrhythmic operation (ER) for postinfarction ventricular tachycardia (VT). This study aimed to determine whether patients at low risk of this outcome could be predicted from a retrospective analysis of variables from 100 consecutive ER patients.
Methods:
Thirteen variables suggested by other researchers as predictive of outcome were analyzed. At the time of study, ER was the only therapy available for drug refractory VT.
Results:
Only emergency ER, wall motion score less than 3 and Killip classification were significantly related to death from cardiac failure. The lack of correlation between emergency ER and variables of ER timing, VT less than 24 hours of ER or VT type implies that the need for emergency ER is also related to ventricular dysfunction. Multivariate analysis identified a group at particularly low risk of death with a specificity of 95%.
Conclusions:
Patients at low risk of death after ER can be identified prospectively. In the implantable cardioverter defibrillator era, elective ER is best reserved for such patients. Emergency ER may still be justified in younger patients without comorbidity who will die of VT without it.