Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization
Anna F Thomsen1, Christian Jøns1, Reza Jabbari1
1Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Insights
Incomplete revascularization after ST-segment elevation myocardial infarction (STEMI) increases long-term arrhythmia risk. This study found incomplete revascularization (ICR) is linked to higher rates of new-onset arrhythmia and mortality compared to complete revascularization (CR).
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Complete revascularization (CR) is known to reduce adverse cardiovascular events post-ST-segment elevation myocardial infarction (STEMI).
- The long-term impact of revascularization status on arrhythmia development after STEMI remains incompletely understood.
Purpose of the Study:
- To investigate the association between incomplete revascularization (ICR) versus CR and the long-term risk of new-onset arrhythmia in STEMI patients.
- To evaluate the impact of revascularization status on specific arrhythmia types and all-cause mortality.
Main Methods:
- Retrospective analysis of 5103 STEMI patients treated with primary percutaneous coronary intervention (PPCI) from 2009-2016.
- Utilized Danish administrative registries to assess outcomes, defining new-onset arrhythmia as a composite of atrial fibrillation/flutter, heart blocks, ventricular tachycardia/fibrillation, or cardiac arrest occurring >7 days post-PPCI.
- Compared outcomes between patients with CR (n=4009) and ICR (n=1094) using adjusted hazard ratios.
Main Results:
- ICR was significantly associated with an increased long-term risk of new-onset arrhythmia compared to CR (HR, 1.33; 95% CI, 1.07-1.66; P=0.01).
- Specific findings included a higher risk of atrial fibrillation (HR, 1.29; P=0.05), ventricular tachycardia/cardiac arrest (HR, 1.77; P=0.02), and all-cause mortality (HR, 1.27; P=0.01) in the ICR group.
- The study included a large cohort with a median age of 62.0 years, 76% of whom were men.
Conclusions:
- In STEMI patients treated with PPCI, incomplete revascularization is linked to a greater long-term risk of developing new-onset arrhythmia.
- ICR is also associated with an increased risk of all-cause mortality in the long-term post-STEMI period.
- These findings underscore the importance of achieving complete revascularization for improved long-term outcomes in STEMI patients.
Aims:
Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia.
Methods And Results:
Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07-1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00-1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10-2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05-1.53; P = 0.01). All HRs adjusted.
Conclusion:
Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR.
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