Prevalence and prognostic implications of non-sustained ventricular tachycardia in ST-segment elevation myocardial infarction after revascularization with either fibrinolysis or primary angioplasty.
OBJECTIVE
We compared the prevalence and prognostic implications of non-sustained ventricular tachycardia (nsVT) detected early after ST-segment elevation myocardial infarction (STEMI) in patients randomized to either fibrinolysis or primary angioplasty in the DANAMI-2 trial.


RESULTS
Holter recordings were available in 1017 patients (fibrinolysis: n=501; primary angioplasty: n=516). Primary endpoint was all-cause mortality. The prevalence of nsVT was 8.8% in fibrinolysis-treated, and 8.1% in primary angioplasty-treated patients (P=0.71). During 4519 patient-years of follow-up (median 4.3 years), 116 patients died [fibrinolysis vs. angioplasty: HR=1.1 (95% CI, 0.8-1.6), P=0.47]. In univariate analysis, nsVT patients treated with fibrinolysis, had significantly higher mortality when compared with those without nsVT (P<0.001). However, after adjustment for other relevant prespecified risk factors, the association between nsVT and mortality did not remain statistically significant. In patients treated with primary angioplasty, nsVT was not associated with mortality in either univariate or multivariate analyses.


CONCLUSIONS
Immediate revascularization with primary angioplasty for STEMI does not affect the subsequent prevalence of nsVT when compared with fibrinolysis. After adjustment for other relevant risk factors, the prognostic value of nsVT detected early after STEMI is limited, regardless of the chosen reperfusion strategy.
Høfsten
Dan Eik
DE
Department of Medical Research, Svendborg Hospital, 5700 Svendborg, and Department of Cardiology, Skejby Sygehus, Arhus University Hospital, Denmark. dan@hoefsten.dk
Wachtell
Kristian
K
Lund
Birgit
B
Mølgaard
Henning
H
Egstrup
Kenneth
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D017130:Angioplasty / Q000401:mortality*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000401:mortality*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology