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Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI.

Publication ,  Journal Article
Rymer, JA; Wegermann, ZK; Wang, TY; Li, S; Smilowitz, NR; Wilson, BH; Jneid, H; Tamis-Holland, JE
Published in: JAMA Netw Open
May 1, 2024

IMPORTANCE: Currently, mortality risk for patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) with an uncomplicated postprocedure course is low. Less is known regarding the risk of in-hospital ventricular tachycardia (VT) and ventricular fibrillation (VF). OBJECTIVE: To evaluate the risk of late VT and VF after primary PCI for STEMI. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adults aged 18 years or older with STEMI treated with primary PCI between January 1, 2015, and December 31, 2018, identified in the US National Cardiovascular Data Registry Chest Pain-MI Registry. Data were analyzed from April to December 2020. MAIN OUTCOMES AND MEASURES: Multivariable logistic regression was used to evaluate the risk of late VT (≥7 beat run of VT during STEMI hospitalization ≥1 day after PCI) or VF (any episode of VF≥1 day after PCI) associated with cardiac arrest and associations between late VT or VF and in-hospital mortality in the overall cohort and a cohort with uncomplicated STEMI without prior myocardial infarction or heart failure, systolic blood pressure less than 90 mm Hg, cardiogenic shock, cardiac arrest, reinfarction, or left ventricular ejection fraction (LVEF) less than 40%. RESULTS: A total of 174 126 eligible patients with STEMI were treated with primary PCI at 814 sites in the study; 15 460 (8.9%) had VT or VF after primary PCI, and 4156 (2.4%) had late VT or VF. Among the eligible patients, 99 905 (57.4%) at 807 sites had uncomplicated STEMI. The median age for patients with late VT or VF overall was 63 years (IQR, 55-73 years), and 75.5% were men; the median age for patients with late VT or VF with uncomplicated STEMI was 60 years (IQR, 53-69 years), and 77.7% were men. The median length of stay was 3 days (IQR, 2-7 days) for the overall cohort with late VT or VF and 3 days (IQR, 2-4 days) for the cohort with uncomplicated STEMI with late VT or VF. The risk of late VT or VF was 2.4% (overall) and 1.7% (uncomplicated STEMI). Late VT or VF with cardiac arrest occurred in 674 patients overall (0.4%) and in 117 with uncomplicated STEMI (0.1%). LVEF was the most significant factor associated with late VT or VF with cardiac arrest (adjusted odds ratio [AOR] for every 5-unit decrease ≤40%: 1.67; 95% CI, 1.54-1.85). Late VT or VF events were associated with increased odds of in-hospital mortality in the overall cohort (AOR, 6.40; 95% CI, 5.63-7.29) and the cohort with uncomplicated STEMI (AOR, 8.74; 95% CI, 6.53-11.70). CONCLUSIONS AND RELEVANCE: In this study, a small proportion of patients with STEMI treated with primary PCI had late VT or VF. However, late VT or VF with cardiac arrest was rare, particularly in the cohort with uncomplicated STEMI. This information may be useful when determining the optimal timing for hospital discharge after STEMI.

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Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

May 1, 2024

Volume

7

Issue

5

Start / End Page

e2410288

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • ST Elevation Myocardial Infarction
  • Risk Factors
  • Registries
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
 

Citation

APA
Chicago
ICMJE
MLA
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Rymer, J. A., Wegermann, Z. K., Wang, T. Y., Li, S., Smilowitz, N. R., Wilson, B. H., … Tamis-Holland, J. E. (2024). Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI. JAMA Netw Open, 7(5), e2410288. https://doi.org/10.1001/jamanetworkopen.2024.10288
Rymer, Jennifer A., Zachary K. Wegermann, Tracy Y. Wang, Shuang Li, Nathaniel R. Smilowitz, B Hadley Wilson, Hani Jneid, and Jacqueline E. Tamis-Holland. “Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI.JAMA Netw Open 7, no. 5 (May 1, 2024): e2410288. https://doi.org/10.1001/jamanetworkopen.2024.10288.
Rymer JA, Wegermann ZK, Wang TY, Li S, Smilowitz NR, Wilson BH, et al. Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI. JAMA Netw Open. 2024 May 1;7(5):e2410288.
Rymer, Jennifer A., et al. “Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI.JAMA Netw Open, vol. 7, no. 5, May 2024, p. e2410288. Pubmed, doi:10.1001/jamanetworkopen.2024.10288.
Rymer JA, Wegermann ZK, Wang TY, Li S, Smilowitz NR, Wilson BH, Jneid H, Tamis-Holland JE. Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI. JAMA Netw Open. 2024 May 1;7(5):e2410288.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

May 1, 2024

Volume

7

Issue

5

Start / End Page

e2410288

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • ST Elevation Myocardial Infarction
  • Risk Factors
  • Registries
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality