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

AbstractBACKGROUND:
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.
AuthorsSana 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
JournalCirculation (Circulation) Vol. 106 Issue 3 Pg. 309-12 (Jul 16 2002) ISSN: 1524-4539 [Electronic] United States
PMID12119245 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
Topics
  • Acute Disease
  • Aged
  • Coronary Disease (diagnosis, drug therapy, epidemiology, mortality)
  • Electrocardiography
  • Female
  • Hospitalization
  • Humans
  • Incidence
  • Male
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Syndrome
  • Tachycardia, Ventricular (diagnosis, drug therapy, epidemiology, mortality)
  • Treatment Outcome
  • Ventricular Fibrillation (diagnosis, drug therapy, epidemiology, mortality)

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