Abstract 6085: Association of Sustained Ventricular Tachycardia/Fibrillation and the Timing of its Occurrence on Outcomes in Patients Undergoing Primary Percutaneous Coronary Interventions: Insights from the APEX-AMI Trial
Ventricular tachycardia/fibrillation (VT/VF) is known to occur in STEMI patients (pts) undergoing primary PCI. However, the association of VT/VF and the timing of its occurrence with outcomes in these pts is poorly understood. We studied 5745 pts undergoing primary PCI from APEX-AMI trial and categorized them in to 2 groups
No VT/VF, and
VT/VF-any time, and those with VT/VF in to
VT/VF before (early) and
VT/VF after (late) the end of PCI. VT/VF occurred in 329 pts (5.7%) with the majority occurring before the end of PCI (64%).
Median time to late VT/VF was 26 hrs after PCI (IQR 3– 63 hrs). On multivariable analyses, factors associated with early VT/VF included heart rate >70 bpm (HR* 1.17, 95% CI 1.07–1.27), creatinine clearance (HR* 0.94, CI 0.90 – 0.99), inferior infarction (HR 2.13, CI 1.55–2.91), pre-PCI TIMI 0 flow (OR 3.03, CI 2.03– 4.52), ST resolution <70% (HR 0.74, 0.54 –1.00), and time from symptom to randomization (HR 0.88, CI 0.79 – 0.99) (c-index 0.74). Factors related with late VT/VF were heart rate >70 bpm (HR* 1.22, 95% CI 1.11–1.33), lower systolic BP (HR* 0.87, CI 0.80 – 0.94), pre-PCI TIMI 0 flow (HR 1.97, CI 1.19 –3.29), no beta-blockers within 24 hours of admission (HR 2.20, CI 1.39 –3.50), post-PCI TIMI <3 flow (OR 2.82, CI 1.73– 4.59), and ST resolution <70% (OR 1.61, CI 1.05–2.48) (c-index 0.74) (*=per 10 unit change). Clinical outcomes up to 90 days were worse in pts with versus those without any VT/VF, especially in pts with late VT/VF (table⇓). VT/VF complicates 1 of every 20 primary PCI with 2/3rd of these occurring before the end of the PCI. Clinical outcomes including 90-day mortality were significantly higher with any VT/VF, but particularly with late VT/VF. Our findings provide new insight in to the incidence and timing of VT/VF in pts undergoing primary PCI and identifies a high risk subset deserving close continuous surveillance in the intensive care setting and a low risk group suitable for early discharge.