Document Detail


Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial.
MedLine Citation:
PMID:  12660676     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In many patients, ventricular arrhythmias will develop early after acute myocardial infarction. We studied the incidence, timing, and outcomes of such arrhythmias in the international Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries (GUSTO)-III trial. METHODS: We identified independent predictors of inhospital ventricular fibrillation (VF) and ventricular tachycardia (VT) and compared 30-day and 1-year mortality rates of patients who did (n = 1121) and did not (n = 13,921) have these arrhythmias during the index hospitalization. RESULTS: Significant independent predictors of inhospital VF were higher Killip class, lower baseline systolic pressure, intravenous preenrollment lidocaine use, shorter time to thrombolysis, and beta-blocker use <2 weeks before enrollment; independent predictors of inhospital VT were lower baseline systolic pressure, intravenous lidocaine use before enrollment, higher Killip class, faster baseline heart rate, and advanced age. The 30-day mortality rate was 31% in patients with VF, 24% in those with VT, 44% in those with both, and 6% in those with neither (P =.001). The corresponding 1-year mortality rates were 34%, 29%, 49%, and 9% (P =.001). The 30-day and 1-year mortality rates were higher for patients with late (>48 hours after enrollment) versus early arrhythmias (< or =48 hours after enrollment). CONCLUSIONS: Despite thrombolysis, inhospital ventricular arrhythmias are associated with higher 30-day and 1-year mortality rates after acute myocardial infarction, particularly when occurring later during the initial hospitalization. Better therapies are needed to improve outcomes of these arrhythmias.
Authors:
Sana M Al-Khatib; Amanda L Stebbins; Robert M Califf; Kerry L Lee; Christopher B Granger; Harvey D White; Paul W Armstrong; Eric J Topol; E Magnus Ohman;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  145     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-27     Completed Date:  2003-06-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  515-21     Citation Subset:  AIM; IM    
Affiliation:
Duke Clinical Research Institute, Durham, NC 27715, USA. alkha001@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aspirin / administration & dosage
Double-Blind Method
Drug Therapy, Combination
Female
Heparin / administration & dosage
Hospital Mortality
Hospitalization
Humans
Male
Middle Aged
Myocardial Infarction / complications*,  drug therapy*
Plasminogen Activators / therapeutic use
Recombinant Proteins / therapeutic use
Streptokinase / therapeutic use*
Tachycardia, Ventricular / etiology,  mortality*
Thrombolytic Therapy*
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Ventricular Fibrillation / etiology,  mortality*
Chemical
Reg. No./Substance:
0/Recombinant Proteins; 133652-38-7/reteplase; 50-78-2/Aspirin; 9005-49-6/Heparin; EC 3.4.-/Streptokinase; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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