Impact of revascularization in patients with post-infarction left ventricular aneurysm and ventricular
Xiaohui Ning1, Zihe Yang2, Xuerui Ye1
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Coronary revascularization improves survival in post-infarction left ventricular aneurysm patients without ventricular tachyarrhythmia. However, for those with ventricular tachycardia or fibrillation, revascularization does not improve cardiac outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Ventricular arrhythmia is a major cause of death in patients with post-infarction left ventricular aneurysm (PI-LVA).
- The impact of coronary revascularization on PI-LVA patients experiencing ventricular tachyarrhythmia is not well understood.
- This study investigates the efficacy of revascularization therapy in this patient population.
Purpose of the Study:
- To determine the effect of coronary revascularization on clinical outcomes in patients with post-infarction left ventricular aneurysm (PI-LVA).
- To assess whether revascularization impacts survival in PI-LVA patients with or without ventricular tachyarrhythmia (VT/VF).
Main Methods:
- A total of 238 PI-LVA patients were analyzed, with 59 presenting sustained ventricular tachycardia (VT) or ventricular fibrillation (VF).
- Patients were categorized into four groups based on treatment (medical vs. revascularization) and VT/VF status.
- The primary endpoint was a composite of cardiac death or heart transplantation, with a follow-up of 45 ± 16 months.
Main Results:
- Revascularization was associated with significantly higher cardiac survival in PI-LVA patients without VT/VF compared to medical therapy (log-rank p = .002).
- In PI-LVA patients with VT/VF, revascularization did not demonstrate a significant improvement in cardiac outcomes (log-rank p = .901).
- Independent predictors of adverse cardiac outcome in VT/VF patients included PET-derived ejection fraction (PET-EF) and moderate/severe mitral regurgitation.
Conclusions:
- Post-infarction left ventricular aneurysm patients with ventricular tachyarrhythmia face a high risk of adverse cardiac events.
- Coronary revascularization does not appear to mitigate the risk of adverse cardiac outcomes in PI-LVA patients with VT/VF.
- Revascularization is linked to improved cardiac survival in PI-LVA patients who do not have VT/VF.
Background:
Ventricular arrhythmia is a leading cause of cardiac death among patients with post-infarction left ventricular aneurysm (PI-LVA). The effect of coronary revascularization in PI-LVA patients with ventricular tachyarrhythmia remains unknown. This study aims to investigate the impact of revascularization therapy on clinical outcomes in these patients.
Methods:
A total of 238 PI-LVA patients were enrolled, and 59 patients were presented with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Patients were classified into 4 groups by treatment strategies (medical or revascularization) and the presence of VT/VF: group 1 (n = 57): VT/VF- and revascularization-; group 2 (n = 122): VT/VF- and revascularization+; group 3 (n = 34): VT/VF+ and revascularization+; and group 4 (n = 25): VT/VF+ and revascularization-. The clinical outcomes were compared, and the primary endpoint was cardiac death or heart transplantation.
Results:
Patients were followed up for 45 ± 16 months, and 41 patients (17.2%) reached the primary endpoint. Kaplan-Meier analysis showed that in VT/VF- patients, revascularization associated with higher cardiac survival compared with medical therapy (log-rank p = .002), but in VT/VF+ patients, revascularization did not predict better cardiac outcome (log-rank p = .901). Cox regression analysis revealed PET-EF (HR 4.41, 95% CI: 1.72-11.36, p = .002) and moderate/severe mitral regurgitation (HR 2.32, 95% CI: 1.02-5.30, p = .046) as independent predictors of adverse cardiac outcome in patients with VT/VF.
Conclusion:
PI-LVA patients with VT/VF are at high risk of adverse cardiac outcome, and coronary revascularization does not mitigate this risk, although revascularization was associated with higher cardiac survival in PI-LVA patients without VT/VF.
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