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Risk stratification for complex ventricular arrhythmia complicating ST-segment elevation myocardial infarction

Podolecki, Tomasz S.a; Lenarczyk, Radoslaw K.a; Kowalczyk, Jacek P.a; Jedrzejczyk-Patej, Ewa K.a; Chodor, Piotr K.a; Mazurek, Michal H.a; Francuz, Pawel J.a; Streb, Witold A.a; Mitrega, Katarzyna A.a; Kalarus, Zbigniew F.b

doi: 10.1097/MCA.0000000000000662
Arrhythmias in CAD

Objectives The primary aim of the study was to evaluate risk factors for ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and to develop the risk score for prediction of VF/VT in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. The secondary aim was to assess the effect of VF/VT on mortality depending on timing of arrhythmia.

Patients and methods We analyzed 4363 consecutive patients with STEMI treated invasively. Among them, 163 patients with pre-reperfusion arrhythmia were excluded from the study. Group ventricular arrhythmias (VA) encompassed patients with VF/VT – those with reperfusion-induced arrhythmia were included into group VA1, whereas group VA2 consisted of patients with postreperfusion arrhythmia. The control group comprised patients free of VF/VT.

Results VF or VT occurred in 313 (7.45%) patients – group VA1 encompassed 103 (32.9%) and group AV2 210 (67.1%) patients. Cardiogenic shock on admission [hazard ratio (HR) 3.5], new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior myocardial infarction (HR 1.6) and symptom-to-balloon time more than 3 h (HR 1.3) were the independent predictors of VF/VT occurrence. In group VA2, the in-hospital and long-term mortality were 4- and 1.5-fold higher than in the arrhythmia-free population (20.5 vs. 4.5% and 36.2 vs. 22.6%, respectively; P<0.001). On the contrary, in group VA1, the long-term mortality was not significantly higher compared with the control group (26.2 vs. 22.6%; P=NS), whereas in-hospital mortality was almost three-fold increased (12.5 vs. 4.5%, respectively; P<0.001).

Conclusion The risk score based on simple clinical parameters might be useful for risk stratification for VF/VT in patients with STEMI. The predictive value of VF/VT was strongly dependent on timing of arrhythmia.

aDepartment of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases

bDepartment of Cardiology, School of Medicine, Division of Dentistry, Zabrze, Poland

Correspondence to Tomasz S. Podolecki, MD, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, 2 Szpitalna Street, 41-800 Zabrze, Poland Tel: +48 323 733 682; fax: +48 323 733 792; e-mail:

Received May 27, 2018

Received in revised form July 19, 2018

Accepted September 3, 2018

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