Effect of primary percutaneous coronary intervention versus thrombolysis on ventricular arrhythmias and heart rate variability in acute myocardial infarction.
BACKGROUND
Several studies showed that thrombolysis reduces ventricular arrhythmias and improves heart rate variability (HRV) in patients with acute myocardial infarction (AMI). Primary percutaneous coronary intervention (PCI) has recently become the treatment of choice for AMI, but it is still unknown whether it has favorable effects on these prognostic variables.


METHODS
We studied a group of 44 consecutive AMI patients (39 males, 5 females, mean age 59 +/- 9 years) submitted to primary PCI and 93 consecutive AMI patients (80 males, 13 females, mean age 61.0 +/- 11 years) treated with thrombolytic therapy within 6 hours of symptom onset. All patients underwent 24-hour Holter recording before discharge.


RESULTS
The number of premature ventricular beats and the prevalence of non-sustained ventricular tachycardia in the 24 hours were lower in the PCI group (162 +/- 474 and 9%, respectively) than in the thrombolysed group (334 +/- 1730 and 14%, respectively), but the difference did not achieve statistical significance (p = 0.62 and p = 0.58, respectively). There were also no significant differences in HRV variables between the two groups, although a lower proportion of PCI patients tended to have bottom quartile values of HRV variables. The favorable trend for arrhythmias and HRV in PCI patients, however, seemed to be related to a worse basal clinical profile of thrombolysed patients, including a higher prevalence of previous AMI (14 vs 2%, p = 0.065), diabetes (27 vs 18%, p = 0.14) and, in particular, a lower use of beta-blockers (35 vs 93%, p < 0.001).


CONCLUSIONS
In this study, we failed to show any significant benefit of primary PCI compared to thrombolysis on ventricular arrhythmias and HRV in patients with ST-segment elevation AMI. The clinical implications of these findings deserve investigation in future studies.
Larosa
Claudio
C
Institute of Cardiology, Catholic University, Rome, Italy.
Infusino
Fabio
F
Sgueglia
Gregory A
GA
Aurigemma
Cristina
C
Sestito
Alfonso
A
Lombardo
Antonella
A
Niccoli
Giampaolo
G
Crea
Filippo
F
Lanza
Gaetano A
GA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D017023:Coronary Angiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome