Ventricular Late Potentials Immediately Post ST-Elevation Myocardial Infarction, and Very Long-Term Mortality
Alexander Shturman1,2, Shira Vardi1, Amitai Bickel3,2
1Department of Cardiology, Galilee Medical Center, Nahariya, Israel.
Insights
Ventricular late potentials (VLP) detected early after ST-elevation myocardial infarction (STEMI) do not predict long-term mortality. This 10-year study found no significant association between VLP and death from any cause or cardiovascular complications.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Outcomes Research
Background:
- The prognostic value of ventricular late potentials (VLP) following ST-elevation myocardial infarction (STEMI) requires further elucidation.
- Long-term outcomes in STEMI patients with VLP are not well-established.
Purpose of the Study:
- To assess the long-term predictive capability of VLP for mortality in patients post-STEMI.
- To investigate the association between early VLP and 10-year all-cause and cardiovascular mortality.
Main Methods:
- Serial signal-averaged electrocardiography (SAECG) was performed on 63 STEMI patients at multiple time points post-admission.
- Patients were followed for 10 years to correlate the presence of VLP with mortality outcomes.
- VLP presence was defined by specific criteria on the averaged QRS complex.
Main Results:
- A higher prevalence of VLP was observed in male patients.
- Over 10 years, 14 patients (22%) died, with 10 deaths from cardiovascular non-arrhythmic complications.
- While 6 deaths occurred in the VLP group versus 3 in the non-VLP group, this difference was not statistically significant (P=0.125).
Conclusions:
- Early detection of ventricular late potentials (VLP) after ST-elevation myocardial infarction (STEMI) does not appear to predict long-term mortality.
- The presence of VLP in the early post-STEMI period is not a significant predictor of either arrhythmic or non-arrhythmic cardiovascular mortality over a 10-year follow-up.
Background:
The very long-term prognostic significance of ventricular late potentials (VLP) in patients post ST-elevation myocardial infarction (STEMI) is unclear.
Objectives:
To evaluate the long-term predictive value of VLP for mortality post-STEMI.
Methods:
We conducted serial signal-averaged electrocardiography (SAECG) measurements in 63 patients on the 1st, 2nd and 3rd day pre-discharge, and 30 days after STEMI in patients admitted in 2001. We followed the patients for 10 years and correlated the presence of VLP with all-cause and cardiovascular mortality.
Results:
The mean age was 59.9 ± 12.3 years. Thrombolysis was performed in 41 patients (65%). Percutaneous coronary intervention was performed pre-discharge in 40 patients (63%) and coronary artery bypass grafting in 7 (11%). Five consecutive measurements to define the presence of VLP were obtained in 52 patients (21 with VLP and 31 without). We found a higher prevalence of VLP in males compared to females (QRS segment > 114 msec, 51% vs. 12%, P = 0.02, duration of the low amplitude signal < 40 mV) in the terminal portion of the averaged QRS complex > 38 msec, 47% vs. 25%, P = 0.05). Over 10 years of follow-up, 14 (22%) patients died, 10 (70%) due to cardiovascular non-arrhythmic complications, 6 with VLP compared to only 3 without (28.6% vs. 9.7%, P = 0.125, hazard ratio = 2.96, confidence intervals = 0.74-11.84) (are these numbers meant to total 10?).
Conclusions:
Over 10 years of follow-up, the presence of VLP in early post-STEMI is not predictive of arrhythmic or non-arrhythmic cardiovascular mortality.
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