Abstract 13168: Sustained Ventricular Tachycardia and Ventricular Fibrillation are Infrequent Events but are Associated with Increased Arrhythmic and All-cause Death Following Non-ST-Segment Elevation Acute Coronary Syndromes
Background: Ventricular arrhythmias remain a lethal complication of acute coronary syndromes. However, the incidence and prognosis of sustained VT/VF in contemporary non-ST-segment elevation acute coronary syndrome (NSTE ACS) populations are not well described.
Methods & Results: We examined the incidence of VT/VF along with clinical characteristics and 30-day mortality among 9406 patients enrolled in the Early Glycoprotein IIb-IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome (EARLY ACS) trial. The cumulative incidence of VT/VF was 1.5% (n=141); 0.7% (n=69) had VT/VF 48 hours after enrollment. Patients with VT/VF were more likely to have prior heart failure (18.4 vs. 12.1%, p=0.02), an ejection fraction <30% (22.4 vs. 4.7%, p=<0.001), and triple-vessel disease (47.0 vs. 31.7%, p<0.001). Patients with VT/VF had an 18-fold higher incidence of 30-day death compared with those without VT/VF (37.6% vs. 2.0%). Cause-specific death is shown in the table.
Conclusions: Sustained VT/VF is an infrequent event in patients who are admitted with NSTE ACS. Although infrequent, sustained VT/VF is distributed equally in the first 48 hours and after 48 hours following admission. Finally, the occurrence of sustained VT/VF is associated with a markedly increased risk of all-cause death and arrhythmic death at 30 days after discharge. These data suggest that patients with NSTE ACS require aggressive monitoring beyond 48 hours and raise important considerations in prevention of arrhythmic death in patients with sustained VT/VF.
- © 2010 by American Heart Association, Inc.