Sustained ventricular arrhythmias among patients with acute coronary syndromes with no ST-segment elevation: incidence, predictors, and outcomes.
BACKGROUND
The prognosis of ventricular arrhythmias among patients with non-ST-elevation acute coronary syndromes is unknown. We studied the incidence, predictors, and outcomes of sustained ventricular arrhythmias in 4 large randomized trials of such patients.


RESULTS
We pooled the datasets of the Global Use of Streptokinase and tPA for Occluded Arteries (GUSTO)-IIb, Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network (PARAGON)-A, and PARAGON-B trials (n=26 416). We identified independent predictors of ventricular fibrillation (VF) and ventricular tachycardia (VT) and compared the 30-day and 6-month mortality rates of patients who did (n=552) and did not (n=25 864) develop these arrhythmias during the index hospitalization. Independent predictors of in-hospital VF included prior hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, and ST-segment changes at presentation. Except for hypertension, these variables also independently predicted in-hospital VT. In Cox proportional-hazards modeling, in-hospital VF and VT were independently associated with 30-day mortality (hazard ratio [HR], 23.2 [95% CI, 18.1 to 29.8] for VF and HR, 7.6 [95% CI, 5.5 to 10.4] for VT) and 6-month mortality (HR, 14.8 [95% CI, 12.1 to 18.3] for VF and HR, 5.0 [95% CI, 3.8 to 6.5] for VT). These differences remained significant after excluding patients with heart failure or cardiogenic shock and those who died <24 hours after enrollment.


CONCLUSIONS
Despite the use of effective therapies for non-ST-elevation acute coronary syndromes, ventricular arrhythmias in this setting are associated with increased 30-day and 6-month mortality. More effective therapies are needed to improve the survival of patients with these arrhythmias.
Duke Clinical Research Institute, Durham, NC 27715, USA. alkha001@mc.duke.edu.
Sana M
SM
Al-Khatib
Christopher B
CB
Granger
Yao
Y
Huang
Kerry L
KL
Lee
Robert M
RM
Califf
Maarten L
ML
Simoons
Paul W
PW
Armstrong
Frans
F
Van de Werf
Harvey D
HD
White
R John
RJ
Simes
David J
DJ
Moliterno
Eric J
EJ
Topol
Robert A
RA
Harrington
D000208:Acute Disease; D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013577:Syndrome; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality