title: Impact of systemic acidosis on the development of malignant ventricular arrhythmias after reperfusion therapy for ST-elevation myocardial infarction.
abstract: BACKGROUND
  The aim of the present study was to examine the effect of systemic acidosis on the development of malignant ventricular arrhythmias, including sustained ventricular tachycardia and ventricular fibrillation (VT/VF), after reperfused ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  A total of 157 consecutive patients with a reperfused STEMI were examined. Patients were divided into 2 groups according to the presence or absence of systemic acidosis, defined as arterial blood pH <7.40 on admission. Serum creatine kinase and C-reactive protein (CRP) levels were serially measured. Systemic acidosis was observed in 53 patients (34%). There was no significant difference in coronary risk factors and arrival time from onset between the 2 groups. Estimated glomerular filtration rate (eGFR) on admission was lower in patients with acidosis than in those without (P=0.001). Patients with acidosis had a higher incidence of VT/VF (26% vs 4%, P<0.0001), especially within 48 h after STEMI (23% vs 3%, P=0.0002), than those without. The peripheral white blood cell count on admission was higher in patients with than in those without acidosis. Multivariate analysis showed that systemic acidosis was a strong independent predictor of VT/VF (relative risk =8.79, P=0.002) among variables including prior MI and eGFR <60 ml . min(-1) . 1.73 m(-2).
  
  
  CONCLUSIONS
  Systemic acidosis was a significant determinant of VT/VF after reperfused STEMI and was associated with elevated serum CRP level. Systemic acidosis and subsequent inflammation after ischemia reperfusion may play an important role in the development of VT/VF.
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nagai
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kaneko
authors.forename: Atsushi
authors.initials: A
authors.lastname: Anzai
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Mano
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nagatomo
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D000138:Acidosis / Q000150:complications*; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D015424:Reperfusion; D017180:Tachycardia, Ventricular / Q000209:etiology; D014693:Ventricular Fibrillation / Q000209:etiology
chemical_list: D002097:C-Reactive Protein