title: Relationship Between Early and Late Nonsustained Ventricular Tachycardia and Cardiovascular Death in Patients With Acute Coronary Syndrome in the Platelet Inhibition and Patient Outcomes (PLATO) Trial.
abstract: BACKGROUND
  Nonsustained ventricular tachycardia (NSVT) is common after acute coronary syndrome (ACS) and a marker of increased risk of arrhythmogenic death. However, the prognostic significance of NSVT when evaluated with other contemporary risk markers and at later time points after ACS remains uncertain.
  
  
  RESULTS
  In the Platelet Inhibition and Patient Outcomes (PLATO) trial, continuous ECGs were performed during the first 7 days after ACS (n=2866) and repeated for another 7 days at day 30 (n=1991). Median follow-up was 1 year. There was a time-varying interaction between NSVT and cardiovascular death such that NSVT was significantly associated with increased risk within the first 30 days after randomization (22/999 [2.2%] versus 16/1825 [0.9%]; adjusted hazard ratio, 2.84; 95% confidence interval, 1.39-5.79; P=0.004) but not after 30 days (28/929 [3.0%] versus 42/1734 [2.4%]; P=0.71). Detection of NSVT during the convalescent phase (n=428/1991; 21.5%) was also associated with an increased risk of cardiovascular death, and was most marked within the first 2 months after detection (1.9% versus 0.3%; adjusted hazard ratio, 5.48; 95% confidence interval, 1.07-28.20; P=0.01), and then decreasing over time such that the relationship was no longer significant by ≈5 months after ACS.
  
  
  CONCLUSIONS
  NSVT occurred frequently during the acute and convalescent phases of ACS. The risk of cardiovascular death associated with NSVT was the greatest during the first 30 days after presentation; however, patients with NSVT detected during the convalescent phase were also at a significantly increased risk of cardiovascular death that persisted for an additional several months after the index event.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: An H
authors.initials: AH
authors.lastname: Bui
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Steen
authors.initials: S
authors.lastname: Husted
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Jianping
authors.initials: J
authors.lastname: Guo
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: KyungAh
authors.initials: K
authors.lastname: Im
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Michelson
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Anders
authors.initials: A
authors.lastname: Himmelmann
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Claes
authors.initials: C
authors.lastname: Held
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Christoph
authors.initials: C
authors.lastname: Varenhorst
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.affiliation: For the author affiliations, please see the Appendix section. bscirica@partners.org.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Scirica
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D000077144:Clopidogrel; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: acute coronary syndrome; cardiovascular death; electrocardiography; sudden cardiac death; tachycardia, ventricular