title: At-admission risk stratification for in-hospital life-threatening ventricular arrhythmias and death in non-ST elevation myocardial infarction patients.
abstract: OBJECTIVE
  Identification of patients with non-ST elevation acute myocardial infarction (NSTEMI) at higher risk of in-hospital life-threatening ventricular arrhythmias (LT-VA) and death is crucial for determining appropriate levels of care/monitoring during hospitalisation. We assessed predictors of in-hospital LT-VA and all-cause mortality in a consecutive series of NSTEMI patients.
  
  
  RESULTS
  We prospectively studied 1325 consecutive patients (69.7% males, median age 70 (61-79) years) presenting with NSTEMI and undergoing continuous electrocardiographic monitoring. The primary study end-point was the occurrence of spontaneous (unrelated to coronary interventions) in-hospital LT-VA, including sustained ventricular tachycardia and ventricular fibrillation; the secondary end-point was in-hospital mortality from all causes. Of 1325 patients, 21 (1.5%) experienced LT-VA and 62 (4.7%) died from either arrhythmias (n=1) or other causes (n=61). Seven of the 20 patients who survived LT-VA subsequently died of heart failure. Independent predictors of in-hospital LT-VA were the Global Registry of Acute Coronary Events (GRACE) score >140 (odds ratio (OR)=7.5; 95% confidence interval (CI) 1.7-33.3; p=0.008) and left ventricular ejection fraction (LV-EF)<35% (OR=4.1; 95% CI 1.7-10.3; p=0.002). GRACE score >140 (OR=14.6; 95% CI 3.4-62) and LV-EF <35% (OR=4.4; 95% CI 1.9-10) also predicted in-hospital all-cause death. The cumulative probability of in-hospital LT-VA and death was respectively 9.2% and 23% in the 98 (7.4%) patients with GRACE score >140 and LV-EF<35%, while it was respectively 0.2% and 0% among the 627 (47.3%) with GRACE score ≤140 and LV-EF ≥35%.
  
  
  CONCLUSIONS
  Simple risk stratification at admission based on GRACE score and echocardiographic LV-EF allows early identification of NSTEMI patients at higher risk of both in-hospital LT-VA and all-cause mortality.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Turri
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Zilio
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Spadotto
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Baritussio
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Peruzza
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gasparetto
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Martina Perazzolo
authors.initials: MP
authors.lastname: Marra
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Cacciavillani
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Marzari
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy domenico.corrado@unipd.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D042241:Early Diagnosis; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D013318:Stroke Volume / Q000502:physiology
keywords: GRACE score; ST segment; ejection fraction; heart failure; myocardial infarction; risk stratification; ventricular arrhythmias