Abstract 12961: Prognostic Significance of Post-Procedural Sustained Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention: Insights from the HORIZONS AMI Trial
Background: Few studies that have evaluated the prognostic significance of sustained ventricular tachycardia or fibrillation (VT/VF) in patients (pts) undergoing primary percutaneous coronary intervention (PCI) have provided conflicting results. Data from the PAMI trial suggested no significant impact while that from APEX-AMI trial showed a strong relationship of VT/VF with death in these pts.
Methods and results: We studied pts from the Harmonizing Outcomes with Revascularization and stents in Acute Myocardial Infarction (HORIZONS-AMI) trial who underwent primary PCI to evaluate the incidence, clinical correlate and outcomes of post-procedural VT/VF. Post-procedural VT/VFoccurred in 181/3485 pts (5.2%). Most baseline clinical and presenting features were similar in pts with and without VT/VF, but those with VT/VF were more likely male (83% vs. 76%) with Killip class >1 (15% vs. 8%) and were less likely to have hypertension (41% vs. 54%) or diabetes (8% vs. 17%). The door to balloon was shorter (88 vs. 100 min) and prevalence of pre-PCI TIMI 0 flow (67% vs. 55%) and 1-vessel PCI was higher in VT/VF pts (99% vs. 96%). The overall use of most treatments at baseline, in-hospital and at discharge was similar in the 2 groups with the exception of lower use of beta-blockers (14% vs. 22%) and ACE inhibitor or ARB at baseline (17% vs. 24%) and ACE/ARB (74% vs. 81%) at discharge in the VT/VF group. Post procedural TIMI 3 flow was similar in the 2 groups (94% vs. 91%). Two-year clinical events did not differ significantly between pts with and without VT/VF (Table).
Conclusions: Post-procedural VT/VF following primary PCI was not associated with increased risk of adverse 2-years event rates, including death. The conflicting data on the prognosis of VT/VF from 3 large randomized clinical trials calls for a future study with systematically collected data targeted specifically to address the prognostic significance of VT/VF in pts undergoing primary PCI.
- © 2010 by American Heart Association, Inc.