Early and late ventricular arrhythmias complicating ST-segment elevation myocardial infarction

Vincent Auffret, Hamed Bourenanea, Sam Sharobeema, Guillaume Leurent, Romain Didier, Martine Gilard, Pierre-Philippe Nicol, Laurent Payot, Emmanuelle Filippi, Jean-Philippe Hacot, Gilles Rouault, Djamel Saouli, Philippe Druelles, Isabelle Coudert, Bertrand Boulanger, Tarik Cherfaoui, Josiane Treuil, Marc Bedossaa, Dominique Boulmier, Marielle Le Guellec, Raphael P. Martins, Hervé Le Breton

Ventricular arrhythmias can be life-threatening complications of ST-segment elevation myocardial infarction (STEMI).

To describe the incidence, predictors and in-hospital impact of early ventricular arrhythmia (EVA, occurring < day 2 after STEMI) and late ventricular arrhythmia (LVA, occurring ≥ day 2 after STEMI) in patients with STEMI.

Data from 13,523 patients enrolled in a prospective registry were analysed. Logistic and Cox regressions were performed to identify predictors of EVA, LVA and in-hospital all-cause mortality. Predictors of LVA were used to build a risk score.

EVA occurred in 678 patients (5%), whereas 120 patients (0.9%) experienced LVA, at a median timing of 3 days after STEMI. EVA was associated with a significantly higher risk of all-cause mortality (hazard ratio: 1.44, 95% confidence interval: 1.17—1.76; P = 0.001), whereas no association was observed with LVA (hazard ratio 0.86, 95% confidence interval 0.57—1.28; P = 0.45). Multivariable predictors of LVA were: age ≥ 65 years; serum creatinine ≥ 85 mol/L on admission; pulse pressure ≤ 45 mmHg on admission; presence of a Q wave on admission electrocardiogram; Thrombolysis In Myocardial Infarction flow grade < 3 after percutaneous coronary intervention; and left ventricular ejection fraction ≤ 45%. The score derived from these variables allowed the classification of patients into four risk categories: low (0—21); low-to-intermediate (22—34); intermediate-to-high (35—44); and high (≥ 45). Observed LVA rates were 0.2%, 0.3%, 0.9% and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow P = 0.23).

EVA is 5-fold more common than LVA in the setting of STEMI, and portends a higher risk of in-hospital all-cause mortality. LVA is mainly associated with the patient’s baseline risk profile and surrogate markers of larger infarct size. We developed and internally validated a risk score identifying patients at high risk of LVA for whom early intensive care unit discharge may not be suitable.