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Incidence of, predictors for, and mortality associated with malignant ventricular arrhythmias in non-ST elevation myocardial infarction patients.
MedLine Citation:
PMID:  20881482     Owner:  NLM     Status:  In-Process    
BACKGROUND: The incidence of non-ST elevation myocardial infarction (NSTEMI) is increasing. Although life-threatening ventricular arrhythmias have been well-documented in patients with ST elevation MI (STEMI), their incidence and importance in NSTEMI have not been examined in similar detail. We examined the incidence, predictors, and mortality rates of ventricular arrhythmias in a cohort of NSTEMI patients undergoing an early invasive strategy.
METHODS: Consecutive patients admitted with NSTEMI who underwent cardiac catheterization within 48 h of admission were identified by chart review. Presence and type of ventricular arrhythmias and 30-day mortality were recorded. Malignant arrhythmias were defined as sustained ventricular tachycardia (VT, >100 beats/min lasting >30 s) or fibrillation (VF). Clinical risk factors, laboratory values, findings on electrocardiogram, echocardiogram, cardiac catheterization, and revascularization procedure data were recorded.
RESULTS: VT/VF occurred in 21 (7.6%) of 277 NSTEMI patients. Sixty percent of these events occurred within the first 48 h after hospital admission, with a median occurrence at 72 h. Twelve patients (4.3%) required defibrillation. Troponin levels were higher and left ventricular ejection fraction was lower in the VT/VF group. Multivariable analysis also identified the presence of left bundle branch block and need for urgent coronary artery bypass grafting as significant predictors of malignant ventricular arrhythmias. Thirty-day mortality was significantly higher in NSTEMI patients with malignant ventricular arrhythmias than without (38 vs. 3%, P<0.001).
CONCLUSION: Despite an early invasive strategy, malignant ventricular arrhythmias are frequent in NSTEMI patients and are associated with increased 30-day mortality.
Shuchita Gupta; Gregg S Pressman; Vincent M Figueredo
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  21     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  460-5     Citation Subset:  IM    
Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
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