Circulation, Vol 87, 312-322, Copyright © 1993 by American Heart Association
AP Maggioni, G Zuanetti, MG Franzosi, F Rovelli, E Santoro, L Staszewsky, L Tavazzi and G Tognoni
BACKGROUND. Several studies performed before the advent of thrombolysis
have shown that the presence of ventricular arrhythmias is an independent
risk factor for subsequent mortality in patients recovering from acute
myocardial infarction. Since fibrinolysis affects the natural history of
infarction and may alter the clinical relevance of different risk factors,
the aim of the present study was to establish the prevalence and prognostic
value of ventricular arrhythmias in post- myocardial infarction patients
treated with fibrinolytic agents during the acute phase. METHODS AND
RESULTS. Twenty-four-hour Holter recordings obtained before discharge from
the hospital in 8,676 post- myocardial infarction patients of the GISSI-2
study were analyzed for the presence of ventricular arrhythmias. Patients
were followed for 6 months from the acute event; total and sudden
cardiovascular mortality rates were computed, and relative risks in
univariate and multivariate analyses were calculated. Ventricular
arrhythmias were present in 64.1% of the patients, more than 10 premature
ventricular beats per hour were recorded in 19.7% of the patients, and
nonsustained ventricular tachycardia was present in 6.8% of the patients.
Ventricular arrhythmias were more frequent when signs or symptoms of left
ventricular damage were present. During follow-up, there was a total of 256
deaths 2.0% in patients without ventricular arrhythmias, 2.7% in patients
with one to 10 premature ventricular beats per hour, 5.5% in those with
more than 10 premature ventricular beats per hour, and 4.8% in those with
complex premature ventricular beats. Even after adjusting for several risk
factors, the presence of frequent (more than 10 premature ventricular beats
per hour) ventricular arrhythmias remained a significant predictor of total
(RRCox, 1.62; 95% confidence interval, 1.16-2.26) and sudden mortality
(RRCox, 2.24; 95% confidence interval, 1.22-4.08). On the other hand, the
presence of nonsustained ventricular tachycardia was not associated with a
worsening of the prognosis in the adjusted analysis (RRCox, 1.20; 95%
confidence interval, 0.80-1.79). CONCLUSIONS. This study shows that
approximately 36% of patients recovering from acute myocardial infarction
presented with less than one premature ventricular beat per hour in Holter
recordings obtained before discharge from the hospital, whereas almost 20%
of patients showed frequent (more than 10 premature ventricular beats per
hour) ventricular arrhythmias. Due to the large size of the population of
this study, these figures may be used as a reliable estimate of the
prevalence of arrhythmias in postinfarction patients treated with
fibrinolytic agents during the acute phase. Frequent premature ventricular
beats are confirmed as independent risk factors of total and sudden death
in the first 6 months following the acute event; the significance of
nonsustained ventricular tachycardia in this population appears more
controversial.
ARTICLES
Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results
GISSI-2 Coordinating Center, Milano, Italy.
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