Ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention and their prognostic value
DOI:
https://doi.org/10.26641/2307-0404.2024.3.313516Keywords:
acute myocardial infarction with ST-segment elevation, risk factors, primary percutaneous coronary intervention, daily electrocardiogram monitoring, ventricular arrhythmias, prognostic valueAbstract
Reperfusion therapy in myocardial infarction patients with acute ST-segment elevation significantly reduced the frequency of ventricular tachycardia and ventricular fibrillation, however, such arrhythmias still occur in 6-8% of patients, posing a threat to their lives.The aim of the study was to determine the nature of ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention, and their prognostic value regarding the development of complications during the inpatient treatment phase. The study involved 82 individuals (mean age: 62,4±10,2 years; male: 69,23 (58,6-78,92)%, female: 30,77 (21,08-41,4)%). Within 24 hours after the infarct-related artery stenting, all patients underwent a 24-hour Holter ECG monitoring. The course of the disease was analyzed based on the presence of risk factors such as hypertension, diabetes mellitus, past COVID-19, and obesity. Ventricular rhythm disturbances were represented mainly by premature contractions. They occurred significantly more frequently in patients with arterial hypertension (883,71 (96,0; 986.0); p=0,02; p=0,03; p=0,02, compared to patients with a history of COVID-19, diabetes, and obesity, respectively) and in those with past COVID-19 (711,3 (125,0; 846,5); p=0,01; p=0,04, compared to individuals with diabetes and obesity, respectively). Isolated premature ventricular complexes, pairs, triplets were recorded, and in individuals with arterial hypertension and past COVID-19 “runs” of ventricular extrasystoles and episodes of nonsustained monomorphic and even polymorphic ventricular tachycardia, such as Torsades de Pointes, (under the condition of combined risk factors) were noted; predominantly in these patients during the hospital phase such сomplications as ventricular fibrillation and asystole,with sudden cardiac arrest developed. The obtained results is an evidence of electrical myocardial instability and indicate that myocardial infarction patients with acute ST-segment elevation, in addition to myocardial revascularization, require optimization of pharmacological treatment. The use of intravenous beta-blockers as part of complex treatment prevented the occurrence of life-threatening ventricular arrhythmias during the inpatient treatment phase.
References
Kyselov SM. [Clinical features of the acute period of myocardial infarction with ST segment elevation in patients after reperfusion therapy]. Zaporozhye medical journal. 2020;22,5(122):597-603. Ukrainian. doi: https://doi.org/10.14739/2310-1210.2020.5.214720
Badiuk NV, Hrebenyk MV. [Cardiac arrhythmias in patients with acute myocardial ischemia, which developed on the background of comorbid hypertension and diabetes]. Bulletin of Medical and Biological Research. 2021;1:5-9. Ukrainian. doi: https://doi.org/10.11603/bmbr.2706-6290.2021.1.11789
Makino T, Ichikawa T, Amino M, Nakamura M, Koshikawa M, Motoike Y, et al. Prognostic significance of the Holter-derived T-wave variability in patients with ventricular tachyarrhythmias complicating acute coronary syndrome-TWIST study. Ann Noninvasive Electrocardiol. 2023;28(6):e13069. doi: https://doi.org/10.1111/anec.13069
Byrne R, Rossello X, Coughlan J, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the mana-gement of acute coronary syndromes. Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 2023;44(38):3720-3826. doi: https://doi.org/10.1093/eurheartj/ehad191
Liang JJ, Fender EA, Cha Y-M, Lennon RJ, Pra-sad A, Barsness GW. Long-term outcomes in survivors of early ventricular arrhythmias after acute st-elevation and non–st-elevation myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol. 2016;117(5):709-13. doi: https://doi.org/10.1016/j.amjcard.2015.12.002
Masuda M, Nakatani D, Hikoso S, Suna S, Usa-mi M, Matsumoto S. Clinical impact of ventricular tachy-cardia and/or fibrillation during the acute phase of acute myocardial infarction on in-hospital and 5-year mortality rates in the percutaneous coronary intervention era. Circ J. 2016;80(7):1539-47. https://doi.org/10.1253/circj.CJ-16-0183
Mehta RH, Yu J, Piccini JP, Tcheng JE, Far-kouh ME, Reiffel J. Prognostic significance of postpro-cedural sustained ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention (from the horizons-ami trial). Am J Cardiol. 2012;109(6):805-12. doi: https://doi.org/10.1016/j.amjcard.2011.10.043
Khederlou H, Azimi Pirsaraei SV, Rabbani E, Motedayen M. Correlations between cardiovascular risk factors and ventricular arrhythmias following primary percutaneous coronary intervention in patients with stelevation myocardial infarction. J Tehran Heart Cent. 2023;2(18):122-8. doi: https://doi.org/10.18502/jthc.v18i2.13322
Deshmukh T, Kovoor JG, Byth K, Chow CK, Zaman S, Chong JH, et al. Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction. Front Cardiovasc Med. 2023;24:10. doi: https://doi.org/10.3389/fcvm.2023.1283382
Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, et al. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace. 2019;21(10):1603-4. doi: https://doi.org/10.1093/europace/euz163
Frampton J, Ortengren AR, Zeitler EP. Аrrhythmias after acute myocardial infarction. Yale J Biol Med. 2023;96(1):83-94. doi: https://doi.org/10.59249/LSWK8578
Nalliah CJ, Zaman S, Narayan A, Sullivan J, Kovoor P. Coronary artery reperfusion for ST elevation myocardial infarction is associated with shorter cycle length ventricular tachycardia and fewer spontaneous arrhythmias. EP Eur. 2014;16(7):1053-60. doi: https://doi.org/10.1093/europace/eut307
Pandozi C, Mariani MV, Chimenti C, Maestrini V, Filomena D, Magnocavallo M, et al. The scar: the wind in the perfect storm-insights into the mysterious living tissue originating ventricular arrhythmias. J Interv Card Electrophysiol. 2023;66(1):27-38. doi: https://doi.org/10.1007/s10840-021-01104-w
Zhao BH, Ruze A, Zhao L, Li QL, Tang J, Xiefukaiti N, et al. The role and mechanisms of microvascular damage in the ischemic myocardium. Cell Mol Life Sci. 2023;80(11):341. doi: https://doi.org/10.1007/s00018-023-04998-z
Faxén J, Xu H, Evans M, Jernberg T, Szummer K, Carrero JJ. Potassium levels and risk of in-hospital arrhythmias and mortality in patients admitted with suspected acute coronary syndrome. Int J Cardiol. 2019;1(274):52-8. doi: https://doi.org/10.1016/j.ijcard.2018.09.099
Podolecki TS, Lenarczyk RK, Kowalczyk JP, Jed-rzejczyk-Patej EK, Chodor PK, Mazurek MH, et al. Risk stratification for complex ventricular arrhythmia compli-cating ST-segment elevation myocardial infarction. Coron Artery Dis. 2018;29(8):681-6. doi: https://doi.org/10.1097/MCA.0000000000000662
Xu X, Wang Z, Yang J, Fan X, Yang Y. Burden of cardiac arrhythmias in patients with acute myocardial infarction and their impact on hospitalization outcomes: insights from China acute myocardial infarction (CAMI) registry. BMC Cardiovasc Disord. 2024;24(1):218. doi: https://doi.org/10.1186/s12872-024-03889-w
Piers S, Wijnmaalen A, Borleffs C, van Huls, van Taxis C, Thijssen J, et al. Early reperfusion therapy affects inducibility, cycle length, and occurrence of ventricular tachycardia late after myocardial infarction. Circ Arrhythm Electrophysiol. 2011;4(2):195-201. doi: https://doi.org/10.1161/CIRCEP.110.959213
Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death developed by the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). European Heart Journal. 2022;43(40):3997-4126. doi: https://doi.org/10.1093/eurheartj/ehac262
Gorenek B, et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Europace. 2019;21(10):1518. doi: https://doi.org/10.1093/europace/euz242
Majidi M, Kosinski AS, Al-Khatib SM, Lemmert ME, Smolders L, van Weert A, et al. Reperfusion ventricular arrhythmia 'bursts' predict larger infarct size despite TIMI 3 flow restoration with primary angioplasty for anterior ST-elevation myocardial infarction. Eur Heart J. 2009;7(30):757-64. doi: https://doi.org/10.1093/eurheartj/ehp005
Sau A, Kaura A, Ahmed A, Patel KK, Li X, Mulla A, et al. Prognostic significance of ventricular arhyth-mias in 13 444 patients with acute coronary syndrome: a retrospective cohort study based on routine clinical data (NIHR health informatics collaborative VA-ACS study). J Am Heart Assoc. 2022;11(6):e024260. doi: https://doi.org/10.1161/JAHA.121.024260
Kovoor JG, Deshmukh T, von Huben A, Marschner SL, Byth K, Chow CK, et al. Optimizing electrophy-siology studies to prevent sudden cardiac death after myocardial infarction. Europace. 2023;25(7):219. doi: https://doi.org/10.1093/europace/euad219
Deshmukh T, Zaman S, Narayan A, Kovoor P. Duration of inducible ventricular tachycardia early after st-segment-elevation myocardial infarction and its impact on mortality and ventricular tachycardia recurrence. J Am Heart Assoc. 2020;9(13):e015204. doi: https://doi.org/10.1161/JAHA.119.015204
Terkelsen CJ, Sørensen JT, Kaltoft AK, Nielsen SS, Thuesen L, Bøtker HE, et al. Prevalence and significance of accelerated idioventricular rhythm in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol. 2009;104(12):1641. doi: https://doi.org/10.1016/j.amjcard.2009.07.037
Rymer JA, Wegermann ZK, Wang TY, Li S, Smilowitz NR, Wilson BH, et al. Ventricular arrhythmias after primary percutaneous coronary intervention for STEMI. JAMA New Open. 2024;7(5):e2410288. doi: https://doi.org/10.1001/jamanetworkopen.2024.10288
Chang H, Chen E, Zhu T, Liu J, Chen C. Communication regarding the myocardial ischemia/reperfusion and cognitive impairment: a narrative literature review. J Alzheimers Dis. 2024;4(97):1545-70. doi: https://doi.org/10.3233/JAD-230886
Silva RR, Magalhães CJ, Silva RD, Tavares de Albuquerque AL, Montenegro ST, Alencar Neto JN. Ac-celerated idioventricular rhythm as anginous substrate in elderly: Report of an unprecedented case. HeartRhythm Case Rep. 2023;10(3):217-21. doi: https://doi.org/10.1016/j.hrcr.2023.12.014
Wu P, Han Y, Chen T, Tu XM. Causal inference for Mann-Whitney-Wilcoxon rank sum and other non-parametric statistics. Stat Med. 2014;33(8):1261-71. doi: https://doi.org/10.1002/sim.6026
Neely JG, Hartman JM, Forsen JW Jr, Wallace MS. Tutorials in clinical research: VII. Understanding comparative statistics (contrast) — part B: application of T-test, Mann-Whitney U, and chisquare. Laryngoscope. 2010;10(113):1719-25. doi: https://doi.org/10.1097/00005537-200310000-00011
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Medicni perspektivi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.