Abstract 2562: Number of Consecutive Ectopic Beats of Non-Sustained Ventricular Tachycardia Episode Predicts Sudden Cardiac Death in Patients With Non-ST-Elevation ACS
INTRODUCTION: In pts with NSTEACS from MERLIN-TIMI 36, non-sustained ventricular tachycardia (NSVT) lasting ≥4 beats was associated with higher risk of sudden cardiac death (SCD), and ranolazine (RAN) significantly reduced incidence of NSVT compared to placebo (PLA). This post-hoc analysis further explores the relationship between the number of consecutive ventricular ectopic beats (VEB) and SCD and whether treatment with RAN may modify this relationship.
METHODS: Continuous Holter was recorded in 6341 pts, who received RAN or PLA on top of standard therapy (Safety Population), during the first 7 days post-randomization. For each pt, the episode with the longest run was used in this analysis. During an average follow-up of 1 year, 121 cases of SCD were identified by central adjudication.
RESULTS: In the PLA group, the number of consecutive VEB was significantly associated with incidence of SCD, from 1.4% in pts with no NSVT to 8.3% in pts with NSVT >20 beats (Fig⇓; p<0.001); in comparison, the association was less pronounced in the RAN group (1.5% no NSVT vs. 3.7% NSVT lasting >20 beats) and the trend did not reach statistical significance (p=0.07; interaction p=0.36). In addition, irrespective of the number of consecutive VEB, treatment with RAN was not associated with higher risk of SCD.
CONCLUSIONS: These results suggest that in pts with NSTEACS, risk of SCD increases with the number of consecutive VEB, and RAN does not exacerbate the risk of SCD associated with longer run of NSVT. A prospectively designed study is needed to verify if these findings may translate into long-term benefit of RAN in pts at higher risk for NSVT and SCD.