Sustained ventricular arrhythmias among patients with acute coronary syndromes with no ST-segment elevation: Incidence, predictors, and outcomes

Sana M. Al-Khatib, Christopher B. Granger, Yao Huang, Kerry L. Lee, Robert M. Califf, Maarten L. Simoons, Paul W. Armstrong, Frans Van De Werf, Harvey D. White, R. John Simes, David J. Moliterno, Eric J. Topol, Robert A. Harrington

Research output: Contribution to journalArticlepeer-review

120 Scopus citations

Abstract

Background - The prognosis of ventricular arrhythmias among patients with non-ST-elevation acute coronary syndromes is unknown. We studied the incidence, predictors, and outcomes of sustained ventricular arrhythmias in 4 large randomized trials of such patients. Methods and Results - We pooled the datasets of the Global Use of Streptokinase and tPA for Occluded Arteries (GUSTO)-IIb, Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network (PARAGON)-A, and PARAGON-B trials (n=26 416). We identified independent predictors of ventricular fibrillation (VF) and ventricular tachycardia (VT) and compared the 30-day and 6-month mortality rates of patients who did (n=552) and did not (n=25 864) develop these arrhythmias during the index hospitalization. Independent predictors of in-hospital VF included prior hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, and ST-segment changes at presentation. Except for hypertension, these variables also independently predicted in-hospital VT. In Cox proportional-hazards modeling, in-hospital VF and VT were independently associated with 30-day mortality (hazard ratio [HR], 23.2 [95% CI, 18.1 to 29.8] for VF and HR, 7.6 [95% CI, 5.5 to 10.4] for VT) and 6-month mortality (HR, 14.8 [95% CI, 12.1 to 18.3] for VF and HR, 5.0 [95% CI, 3.8 to 6.5] for VT). These differences remained significant after excluding patients with heart failure or cardiogenic shock and those who died <24 hours after enrollment. Conclusions - Despite the use of effective therapies for non-ST-elevation acute coronary syndromes, ventricular arrhythmias in this setting are associated with increased 30-day and 6-month mortality. More effective therapies are needed to improve the survival of patients with these arrhythmias.

Original languageEnglish
Pages (from-to)309-312
Number of pages4
JournalCirculation
Volume106
Issue number3
DOIs
StatePublished - Jul 16 2002

Keywords

  • Coronary disease
  • Fibrillation
  • Mortality
  • Prognosis
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint

Dive into the research topics of 'Sustained ventricular arrhythmias among patients with acute coronary syndromes with no ST-segment elevation: Incidence, predictors, and outcomes'. Together they form a unique fingerprint.

Cite this