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Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial.

Publication ,  Journal Article
Al-Khatib, SM; Stebbins, AL; Califf, RM; Lee, KL; Granger, CB; White, HD; Armstrong, PW; Topol, EJ; Ohman, EM; GUSTO-III trial,
Published in: Am Heart J
March 2003

BACKGROUND: In many patients, ventricular arrhythmias will develop early after acute myocardial infarction. We studied the incidence, timing, and outcomes of such arrhythmias in the international Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries (GUSTO)-III trial. METHODS: We identified independent predictors of inhospital ventricular fibrillation (VF) and ventricular tachycardia (VT) and compared 30-day and 1-year mortality rates of patients who did (n = 1121) and did not (n = 13,921) have these arrhythmias during the index hospitalization. RESULTS: Significant independent predictors of inhospital VF were higher Killip class, lower baseline systolic pressure, intravenous preenrollment lidocaine use, shorter time to thrombolysis, and beta-blocker use <2 weeks before enrollment; independent predictors of inhospital VT were lower baseline systolic pressure, intravenous lidocaine use before enrollment, higher Killip class, faster baseline heart rate, and advanced age. The 30-day mortality rate was 31% in patients with VF, 24% in those with VT, 44% in those with both, and 6% in those with neither (P =.001). The corresponding 1-year mortality rates were 34%, 29%, 49%, and 9% (P =.001). The 30-day and 1-year mortality rates were higher for patients with late (>48 hours after enrollment) versus early arrhythmias (< or =48 hours after enrollment). CONCLUSIONS: Despite thrombolysis, inhospital ventricular arrhythmias are associated with higher 30-day and 1-year mortality rates after acute myocardial infarction, particularly when occurring later during the initial hospitalization. Better therapies are needed to improve outcomes of these arrhythmias.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2003

Volume

145

Issue

3

Start / End Page

515 / 521

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Tachycardia, Ventricular
  • Streptokinase
  • Recombinant Proteins
  • Plasminogen Activators
  • Myocardial Infarction
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Al-Khatib, S. M., Stebbins, A. L., Califf, R. M., Lee, K. L., Granger, C. B., White, H. D., … GUSTO-III trial, . (2003). Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J, 145(3), 515–521. https://doi.org/10.1067/mhj.2003.170
Al-Khatib, Sana M., Amanda L. Stebbins, Robert M. Califf, Kerry L. Lee, Christopher B. Granger, Harvey D. White, Paul W. Armstrong, Eric J. Topol, E Magnus Ohman, and E Magnus GUSTO-III trial. “Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial.Am Heart J 145, no. 3 (March 2003): 515–21. https://doi.org/10.1067/mhj.2003.170.
Al-Khatib SM, Stebbins AL, Califf RM, Lee KL, Granger CB, White HD, et al. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J. 2003 Mar;145(3):515–21.
Al-Khatib, Sana M., et al. “Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial.Am Heart J, vol. 145, no. 3, Mar. 2003, pp. 515–21. Pubmed, doi:10.1067/mhj.2003.170.
Al-Khatib SM, Stebbins AL, Califf RM, Lee KL, Granger CB, White HD, Armstrong PW, Topol EJ, Ohman EM, GUSTO-III trial. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J. 2003 Mar;145(3):515–521.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2003

Volume

145

Issue

3

Start / End Page

515 / 521

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Tachycardia, Ventricular
  • Streptokinase
  • Recombinant Proteins
  • Plasminogen Activators
  • Myocardial Infarction
  • Middle Aged