Abstract 15319: Low Serum Eicosapentaenoic Acid Level is a Risk for Ventricular Arrhythmia in Patients With Acute Myocardial Infarction: A Possible Link to J-Waves
Backgrounds: Eicosapentaenoic acid (EPA) has antiarrhythmic effects. Recent studies suggest that J-wave on ECG is associated with a high incidence of ventricular tachycardia/fibrillation (VT/VF). We evaluated relationships between EPA and J-wave and their involvement in the occurrence of VT/VF in acute myocardial infarction (AMI).
Methods and Results: Consecutive 200 patients undergoing successful percutaneous coronary intervention (PCI) within 12 hours after AMI onset were enrolled. ECG was recorded before PCI and presence of J-wave was evaluated. Serum EPA level at admission was measured, and the relationships among the serum EPA level, J-wave, and incidence of VT/VF in the acute phase including pre-hospital phase were investigated. The patients were divided into two groups according to the optimal cutoff value (2.94) of serum EPA level (% of total fatty acids), which was subsequently determined by Receiver Operating Characteristic curve: LOW (<2.94, 61±11 years, n=103) and HIGH groups (≥ 2.94, 70±13 years, n=81). J-waves were observed more frequently in LOW (36/103, 35%) than in HIGH group (16/81, 20%) (p=0.020). 30-day incidence of VT/VF including those occurring before admission was higher in LOW (19.5%) than in HIGH group (6.2%) (p=0.009). The patients with J-waves showed a higher incidence of VT/VF (23.1%) than those without J-waves (9.9%) (p=0.019). Kaplan-Meier analysis showed that the highest incidence of VT/VF was observed in LOW with J-wave group (27.8%), followed by LOW without J-wave (15.0%), HIGH with J-wave (12.5%) and HIGH without J-wave (4.6%) (p=0.013). Because of a significant relationship between presence of J-waves and serum EPA level, those valuables were added separately in a Cox proportional hazard analysis. Killip grade II-IV (HR, 4.15; 95%CI, 1.79-9.62, p=0.001) and low serum EPA level (HR, 2.23; 95% CI, 1.02-4.90, p=0.046) in model 1, and Killip grade (HR, 3.73; 95 CI, 1.67-8.33, p=0.001) and presence of J-waves (HR, 2.72; 95% CI, 1.01-7.23, p=0.048) in model 2 were significantly associated with the incidence of VT/VF.
Conclusions: Low serum EPA level is a risk for incidence of VT/VF in the acute phase of AMI. Involvement of J-wave and its possible link with EPA in the pathogenesis of ischemia-induced VT/VF are suggested.
- © 2013 by American Heart Association, Inc.