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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Risk stratification for complex ventricular arrhythmia complicating ST-segment elevation myocardial infarction
Tomasz S Podolecki1, Radoslaw K Lenarczyk1, Jacek P Kowalczyk1
1Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases.
Insights
This study identified key predictors of ventricular fibrillation/sustained ventricular tachycardia (VF/VT) in ST-segment elevation myocardial infarction (STEMI) patients. Developing a risk score can aid in predicting VF/VT and understanding its impact on mortality.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
- Ventricular arrhythmias, specifically ventricular fibrillation/sustained ventricular tachycardia (VF/VT), are significant complications in STEMI patients.
- Understanding the risk factors and prognostic implications of VF/VT is crucial for improving patient outcomes.
Purpose of the Study:
- To identify independent risk factors for the occurrence of VF/VT in STEMI patients undergoing invasive treatment.
- To develop a predictive risk score for VF/VT in this patient population.
- To evaluate the impact of VF/VT timing (pre-reperfusion vs. post-reperfusion) on in-hospital and long-term mortality.
Main Methods:
- Analysis of 4363 consecutive STEMI patients treated invasively.
- Exclusion of 163 patients with pre-reperfusion arrhythmia.
- Categorization into groups: reperfusion-induced VF/VT (VA1), post-reperfusion VF/VT (VA2), and arrhythmia-free control group.
Main Results:
- VF/VT occurred in 7.45% of patients.
- Independent predictors of VF/VT included cardiogenic shock, new-onset atrial fibrillation, incomplete revascularization, prior myocardial infarction, and prolonged symptom-to-balloon time.
- Post-reperfusion VF/VT (VA2) was associated with significantly higher in-hospital and long-term mortality compared to the control group.
- Reperfusion-induced VF/VT (VA1) showed increased in-hospital mortality but not significantly higher long-term mortality.
Conclusions:
- A risk score utilizing simple clinical parameters can effectively stratify VF/VT risk in STEMI patients.
- The timing of VF/VT occurrence significantly influences its predictive value for mortality.
- Early identification of high-risk patients for VF/VT is essential for targeted management strategies.
Objectives:
The primary aim of the study was to evaluate risk factors for ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and to develop the risk score for prediction of VF/VT in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. The secondary aim was to assess the effect of VF/VT on mortality depending on timing of arrhythmia.
Patients And Methods:
We analyzed 4363 consecutive patients with STEMI treated invasively. Among them, 163 patients with pre-reperfusion arrhythmia were excluded from the study. Group ventricular arrhythmias (VA) encompassed patients with VF/VT - those with reperfusion-induced arrhythmia were included into group VA1, whereas group VA2 consisted of patients with postreperfusion arrhythmia. The control group comprised patients free of VF/VT.
Results:
VF or VT occurred in 313 (7.45%) patients - group VA1 encompassed 103 (32.9%) and group AV2 210 (67.1%) patients. Cardiogenic shock on admission [hazard ratio (HR) 3.5], new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior myocardial infarction (HR 1.6) and symptom-to-balloon time more than 3 h (HR 1.3) were the independent predictors of VF/VT occurrence. In group VA2, the in-hospital and long-term mortality were 4- and 1.5-fold higher than in the arrhythmia-free population (20.5 vs. 4.5% and 36.2 vs. 22.6%, respectively; P<0.001). On the contrary, in group VA1, the long-term mortality was not significantly higher compared with the control group (26.2 vs. 22.6%; P=NS), whereas in-hospital mortality was almost three-fold increased (12.5 vs. 4.5%, respectively; P<0.001).
Conclusion:
The risk score based on simple clinical parameters might be useful for risk stratification for VF/VT in patients with STEMI. The predictive value of VF/VT was strongly dependent on timing of arrhythmia.
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