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Original article

Vol. 142 No. 2324 (2012)

Incidence and time frame of life-threatening arrhythmias in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

  • Patrizia Cricri
  • Lukas D. Trachsel
  • Peter Müller
  • Adrian Wäckerlin
  • Walter H. Reinhart
  • Piero O. Bonetti
DOI
https://doi.org/10.4414/smw.2012.13604
Cite this as:
Swiss Med Wkly. 2012;142:w13604
Published
03.06.2012

Summary

BACKGROUND: Life-threatening arrhythmias may complicate the hospital course of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). The optimal duration of electrocardiographic monitoring in such patients is not well established. We aimed to determine the incidence and the time of occurrence of life-threatening arrhythmias in STEMI patients undergoing PPCI.

METHODS: Data of 382 consecutive patients with STEMI undergoing PPCI were analysed regarding the occurrence of ventricular fibrillation (VF), sustained ventricular tachycardia (sVT) or bradycardia necessitating temporary or permanent pacing.

RESULTS: Of these patients, 55% had inferior STEMI, 41% anterior and 4% lateral STEMI. The infarct-related arteries were the right in 41%, the left anterior descending in 41%, the left circumflex in 16%, the left main stem in 1% and a vein graft in <1%. During hospitalisation, 27 (7.0%) patients developed 29 life-threatening arrhythmias (incidence 7.6%): 19 episodes occurred during PPCI (VF n = 11, bradycardia n = 8), 9 episodes during the first 24 hours after PPCI (VF n = 7, sVT n = 2), and 1 sVT episode in a hypokalemic patient on the 4th post-procedural day. A total of 17 patients (4.5%) died within the first 30 days, and 3 of these died during the PPCI procedure.

CONCLUSIONS: Life-threatening arrhythmias occur in a considerable proportion of STEMI patients undergoing PPCI during hospitalisation. Most of these arrhythmias occur during the PPCI procedure. Post-procedural life-threatening arrhythmias are virtually limited to the first 24 hours after PPCI. Thus, routine electrocardiographic monitoring beyond the first 24 hours after PPCI might not be required in most patients with uncomplicated STEMI.

References

  1. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Eur Heart J. 2008;29:2909–45.
  2. Antman EM, Hand M, Armstrong PW, Bates PW, Green LE, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. J Am Coll Cardiol. 2008;51:210–47.
  3. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction 2004. J Am Coll Cardiol. 2004;44:E1–211.
  4. Drew BJ, Califf RM, Funk M, Kaufman ES, Krucoff MW, Laks MM, et al. Practice standards for electrocardiographic monitoring in hospital settings. Circulation. 2004;110:2721–46.
  5. Hasin Y, Danchin N, Filippatos GS, Heras M, Janssens U, Leor J, et al. Recommendations for the structure, organization, and operation of intensive cardiac care units. Eur Heart J. 2005;26:1676‒82.
  6. Muth K, Senges J, Zeymer U. Monitoring after acute myocardial infarction. Dtsch Med Wochenschr. 2007;132:2021–3.
  7. The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined – a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. Eur Heart J. 2000;21:1502–13 and J Am Coll Cardiol. 2000;36:959–69.
  8. Newby KH, Thompson T, Stebbins A, Topol EJ, Califf RM, Natale A. Sustained ventricular arrhythmias in patients receiving thrombolytic therapy: incidence and outcomes. Circulation. 1998;98:2567–73.
  9. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O’Keefe J, et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1993;328:673–9.
  10. Zijlstra F, de Boer MJ, Hoorntje JCA, Reifers S, Reiber JHC, Suryapranata H. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med. 1993;328:680–4.
  11. Mehta RH, Starr AZ, Lopes RD, Hochman JS, Widimsky P, Pieper KS, et al., for the APEX AMI Investigators. Incidence of an outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention. JAMA. 2009;301:1779–89.
  12. Ohlow MA, Geller JC, Richter S, Farah A, Müller S, Fuhrmann JT, Lauer B. Incidence and predictors of ventricular arrhythmias after ST-segment elevation myocardial infarction. Am J Emerg Med. in press, available online 11 May 2011.
  13. Giglioli C, Margheri M, Valente S, Comeglio M, Lazzeri C, Chechi T, et al. Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous intervention. Can J Cardiol. 2006:22:1047–52.
  14. Newby LK, Hasselblad V, Armstrong PW, Van de Werf F, Mark DB, White HD, et al. Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J. 2003;24:182–9.
  15. Koeth O, Nibbe L, Arntz HR, Dirks B, Ellinger K, Genzwürker H, et al., for the PREMIR Investigators. Fate of patients with prehospital resuscitation for ST-elevation myocardial infarction and a high rate of early reperfusion therapy. Am J Cardiol. 2012; in press.
  16. Mehta RH, Harjai KJ, Grines L, Stone GW, Boura J, Cox D, et al., on behalf of the Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention. J Am Coll Cardiol. 2004;43:1765–72.
  17. Piccini JP, Berger JS, Brown DL. Early sustained ventricular arrhythmias complicating acute myocardial infarction. Am J Med. 2008;121:797–804.
  18. Mehta RH, Starr AZ, Lopes RD, Piccini JP, Patel MR, Pieper KS, et al. Relationship of sustained ventricular tachyarrhythmias to outcomes in patients undergoing primary percutaneous coronary intervention with varying underlying baseline risk. Am Heart J. 2011;161:782–9.