Abstract 3325: Association of Ventricular Fibrillation and Ventricular Tachycardia (VT/VF) with Impaired TIMI Myocardial Perfusion Grades (TMPG) Even in the Presence of Normal TIMI Grade 3 Flow
Background: Impaired myocardial perfusion (TMPG) following successful restoration of TIMI Grade 3 Flow (TGF 3) has been associated with adverse clinical outcomes in numerous trials. The association of impaired myocardial perfusion (TMPG) with ventricular arrhythmias has not been evaluated.
Methods: Angiographic data were analyzed from 3,491 patients enrolled in the CLARITY-TIMI 28 trial who underwent angiography at a median of 3.5 days following fibrinolytic therapy.
Results: VT/VF was observed in 4.8% (167 / 3,491) of pts by 30 days. VT/VF was associated with impaired epicardial flow and myocardial perfusion (Table⇓). Of note, even among patients with successful restoration of TFG 3, the incidence of VT/VF was significantly higher among patients with persistent abnormalities in TMPG (TMPG 0/1/2 ± 4.7% (34/721), vs TMPG 3 ± 2.7% (36/1,340); (HR 1.82, 95% CI 1.14, 2.92; p= 0.013). Furthermore, among patients with TFG 3, all fatal instances of VT/VF that occurred late, were observed among those patients with TMPG 0/1 (2/656 vs 0/1405, p=0.038, p=0.10 by Fisher’s exact test). The risk of VT/VF tended to be higher in patients with TMPG 0/1/2 before angio (HR 1.51, 95% CI 0.97,2.33; p=0.07) and and was significantly higher in those with TMPG 0/1/2 after angio (HR 4.85, 95% CI 2.12, 11.06; p<0.0001).
Conclusion: VT/VF while infrequent is associated with a higher risk of mortality and re MI. VT/VF was associated with impairments in both epicardial and myocardial perfusion. Despite restoration of normal TIMI grade 3 epicardial flow, persistently impaired TIMI myocardial perfusion on angiography 3.5 days after fibrinolytic administration was associated with an almost 5-fold higher risk of VT/VF after angiography by 30 days.