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Sustained ventricular tachycardia and ventricular fibrillation complicating non-ST-segment-elevation acute coronary syndromes.

Publication ,  Journal Article
Piccini, JP; White, JA; Mehta, RH; Lokhnygina, Y; Al-Khatib, SM; Tricoci, P; Pollack, CV; Montalescot, G; Van de Werf, F; Gibson, CM; Newby, LK ...
Published in: Circulation
July 3, 2012

BACKGROUND: Ventricular arrhythmias remain a lethal complication of acute coronary syndromes (ACS). However, the incidence and prognosis of sustained ventricular tachycardia/ventricular fibrillation (VT/VF) in contemporary non-ST-segment-elevation (NSTE) ACS populations are not well described. METHODS AND RESULTS: We examined the incidence of VT/VF and subsequent survival among 9211 patients enrolled in the Early Glycoprotein IIb/IIIa Inhibition in NSTE ACS (EARLY ACS) trial. The cumulative incidence of VT/VF was 1.5% (n=141); 0.6% (n=55) had VT/VF ≤48 hours after enrollment, and 0.9% (n=86) had VT/VF >48 hours after enrollment. Patients with VT/VF more frequently had prior heart failure, an ejection fraction <30%, and triple-vessel coronary artery disease. Predictors of sustained VT/VF were similar regardless of the timing of VT/VF (≤48 versus >48 hours). Patients with VT/VF ≤48 hours after enrollment had higher 30-day mortality than those who did not have VT/VF ≤48 hours (13.0% versus 2.2%; adjusted odds ratio, 6.73; 95% confidence interval, 2.68-16.9). The increased risk of death associated with VT/VF ≤48 hours persisted at 1 year. The risk of mortality, relative to patients without VT/VF, was greater for patients with VT/VF >48 hours (hazard ratio, 20.70; 95% confidence interval, 15.39-27.85) than for those with earlier VT/VF (hazard ratio, 7.45; 95% confidence interval, 4.60-12.08; P=0.0003). The frequency of arrhythmic death was higher in patients with VT/VF than in those without VT/VF (26.4% versus 6.9%). CONCLUSIONS: Sustained VT/VF is infrequent after NSTE ACS but is as likely to occur after 48 hours as within the first 48 hours. The marked increase in all-cause death among NSTE ACS patients with both early and late sustained VT/VF raises important considerations for aggressive monitoring beyond 48 hours and interventions to prevent arrhythmic death in these patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00089895.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 3, 2012

Volume

126

Issue

1

Start / End Page

41 / 49

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Middle Aged
  • Male
  • Humans
  • Female
  • Double-Blind Method
  • Cohort Studies
  • Cardiovascular System & Hematology
 

Citation

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Piccini, J. P., White, J. A., Mehta, R. H., Lokhnygina, Y., Al-Khatib, S. M., Tricoci, P., … Newby, L. K. (2012). Sustained ventricular tachycardia and ventricular fibrillation complicating non-ST-segment-elevation acute coronary syndromes. Circulation, 126(1), 41–49. https://doi.org/10.1161/CIRCULATIONAHA.111.071860
Piccini, Jonathan P., Jennifer A. White, Rajendra H. Mehta, Yuliya Lokhnygina, Sana M. Al-Khatib, Pierluigi Tricoci, Charles V. Pollack, et al. “Sustained ventricular tachycardia and ventricular fibrillation complicating non-ST-segment-elevation acute coronary syndromes.Circulation 126, no. 1 (July 3, 2012): 41–49. https://doi.org/10.1161/CIRCULATIONAHA.111.071860.
Piccini JP, White JA, Mehta RH, Lokhnygina Y, Al-Khatib SM, Tricoci P, et al. Sustained ventricular tachycardia and ventricular fibrillation complicating non-ST-segment-elevation acute coronary syndromes. Circulation. 2012 Jul 3;126(1):41–9.
Piccini, Jonathan P., et al. “Sustained ventricular tachycardia and ventricular fibrillation complicating non-ST-segment-elevation acute coronary syndromes.Circulation, vol. 126, no. 1, July 2012, pp. 41–49. Pubmed, doi:10.1161/CIRCULATIONAHA.111.071860.
Piccini JP, White JA, Mehta RH, Lokhnygina Y, Al-Khatib SM, Tricoci P, Pollack CV, Montalescot G, Van de Werf F, Gibson CM, Giugliano RP, Califf RM, Harrington RA, Newby LK. Sustained ventricular tachycardia and ventricular fibrillation complicating non-ST-segment-elevation acute coronary syndromes. Circulation. 2012 Jul 3;126(1):41–49.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 3, 2012

Volume

126

Issue

1

Start / End Page

41 / 49

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Middle Aged
  • Male
  • Humans
  • Female
  • Double-Blind Method
  • Cohort Studies
  • Cardiovascular System & Hematology