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Prognosis of the non-ST elevation myocardial infarction complicated with early ventricular fibrillation at higher age

Réka Skoda1, György Bárczi1, Hajnalka Vágó1

  • 1Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.

Geroscience
|May 15, 2021
PubMed

Insights

Early ventricular fibrillation (EVF) is a significant mortality predictor in non-ST-segment elevation myocardial infarction (NSTEMI) patients, regardless of age. Invasive management and closer follow-up are crucial for survivors.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Critical Care Medicine

Background:

  • Early ventricular fibrillation (EVF) is a known mortality predictor in ST-segment elevation myocardial infarction (STEMI).
  • Prognosis and management strategies for EVF in non-ST-segment elevation myocardial infarction (NSTEMI) patients, particularly older individuals, remain understudied.
  • There is a lack of clear prognostic guidance for NSTEMI patients who survive EVF in clinical practice.

Purpose of the Study:

  • To investigate the risk factors associated with EVF in NSTEMI patients.
  • To identify factors influencing the prognosis of NSTEMI patients who survive EVF, with a focus on older age groups.
  • To provide evidence-based recommendations for the management and follow-up of NSTEMI patients experiencing EVF.

Main Methods:

  • Analysis of clinical data from 6179 NSTEMI patients, including 151 survivors of EVF.
  • Comparison of 30-day and 1-year mortality rates between age groups (below and above 70 years) using chi-square tests, uni- and multivariate analyses, and Kaplan-Meier survival analysis.
  • Evaluation of clinical characteristics and outcomes, including the impact of early revascularization.

Main Results:

  • EVF was identified as an independent risk factor for mortality in NSTEMI patients across both age groups (below 70: HR 2.4; above 70: HR 2.1).
  • Mortality rates did not differ significantly between age groups: 30-day mortality (24% vs 40%, p=0.2709) and 1-year mortality (39% vs 55%, p=0.2085).
  • EVF occurring after revascularization within 48 hours was associated with an 11.2-fold increased risk of 30-day mortality in patients over 70.

Conclusions:

  • EVF is a significant independent predictor of mortality in NSTEMI patients, irrespective of age.
  • Invasive management and prompt revascularization are strongly recommended for NSTEMI patients experiencing EVF.
  • Closer patient follow-up and careful selection for implantable cardioverter-defibrillator (ICD) implantation, particularly within the first critical month post-event, are essential, regardless of patient age.

Keywords:
AgingEarly ventricular fibrillationNSTEMIPrognosis

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