Abstract 5336: Presence of Ischemia and Non-Sustained Ventricular Tachycardia is Strongly Associated With the Risk of Cardiovascular Outcomes: Observations From the MERLIN-TIMI 36 Trial
Background: Among pts with NSTEACS, recurrent ischemia and ventricular arrhythmias detected on continuous ECG (cECG) remain common clinical events with uncertain clinical significance.
Methods: We determined the risk associated with the presence of ischemia (> 1mm ST depression lasting > 1min) and NSVT (> 4beats) alone or combined on 7-day cEKG in 6355 pts with NSTEACS. Pts were categorized into 4 groups:
No ischemia or NSVT,
Ischemia alone or
Both ischemia and NSVT.
Median clinical follow-up was 348 days.
Results: A total of 43.6% pts had no VT or ischemia; 31.2% had NSVT alone; 18.5% had ischemia alone; and 6.8% had both NSVT and ischemia. Pts with either NSVT or ischemia on cECG were at increased risk of CV outcomes (Table⇓). In a MV analysis, recurrent ischemia alone increased the risk of all CV outcomes while NSVT alone increased the risk of CVD, SCD, and subsequent heart failure. Pts with both ischemia and NSVT were at high-risk for CVD (10.1 v 3.0%, p<0.001), SCD (7.8 v 0.9%, p<0.001), recurrent MI (15.4 v 6.2%, p<0.001) and heart failure (13.0 v 3.0%, p<0.001) compared to pts with neither. In pts with both ischemia and NSVT, 47.1% of SCD occurred within 90d (Figure⇓).
Conclusion: In more than 6300 pts with NSTEACS, the presence of either ischemia or NSVT alone or particularly in combination was independently associated with poor CV outcomes, including a particularly high risk for early SCD. These findings raise the question whether such pts should be considered for ICD implantation.