Predicting survival with reperfusion arrhythmias during primary percutaneous coronary intervention for acute myocardial infarction.
BACKGROUND
The significance of arrhythmia occurring after successful recanalization of an occluded artery during treatment following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction is controversial.


OBJECTIVE
To study the association of reperfusion arrhythmia with short and long-term survival.


METHODS
We used a prospective registry of consecutive STEMI patients undergoing PPCI. Patients with an impaired epicardial flow (TIMI flow grade < 3) at the end of the procedure were excluded.


RESULTS
Of the 688 patients in the study group, 22% were women. Mean (+/- SD) age of the cohort was 61 (+/- 14) years and frequent co-morbidities included diabetes mellitus (25%), dyslipidemia (55%), hypertension (43%) and smoking (41%). RA was recorded in 200 patients (29%). Patients with RA had lower rates of diabetes (16% vs. 30%, P < 0.01) and hypertension (48% vs. 62%, P < 0.01), and a shorter median pain-to-balloon time (201 vs. 234 minutes, P < 0.01) than patients without RA. Thirty day mortality was 3.7% and 8.3% for patients with and without RA, respectively (P = 0.04). After controlling for age, gender and pain-to-balloon time the hazard ratio for mortality for patients with RA during a median follow-up period of 466 days was 0.46 (95% confidence interval 0.23-0.92).


CONCLUSIONS
The occurrence of RA immediately following PPCI for acute STEMI is associated with better clinical characteristics and identifies a subgroup with a particularly favorable prognosis.
Ilia
Reuben
R
Department of Cardiology, Soroka University Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. iliar@bgu.ac.il
Zahger
Doron
D
Cafri
Carlos
C
Abu-Ful
Akram
A
Weinstein
Jean Marc
JM
Yaroslavtsev
Sergey
S
Gilutz
Harel
H
Amit
Guy
G
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome