The importance of early and late ventricular arrhythmias detection and prediction in acute myocardial infarction

Abstract Background Malignant arrhythmias, ventricular tachycardia or ventricular fibrillation (VT/VF) in acute myocardial infarction (AIM) carry ominous prognosis including sudden cardiac death (SCD). It is not clear whether the timing of VT/VF occurrence always affects the poor prognosis of patients with AMI. Aim To investigate the prognosis of patients who undergoing primary percutaneous coronary intervention (PCI) in accordance with timing of VT/VF and to find the power predictors of their occurrence. Methods 307 consecutive patients in PREDICT-VT study (NCT03263949), 57.9±10.6 year old, 72.3% males were analysed. Of these patients, 27.7% had VT/VF from the symptoms onset, within 48 hours of AIM (early VT/VF group). 8.1% of patients had VT/VF after 48h, during one year follow up (late VT/VF group). Results The frequency of VT/VF occurrence was high between symptoms onset and the end of 2nd month and during 5th and 6th month of AIM. The parameters of conventional echocardiography were significantly impaired in late VT/VF group, as well as parameters of longitudinal strain (LS) (table). Moreover, the MACE (cardiovascular mortality, SCD, new infarction, emergency revascularisation, and hospitalized heart failure) was the highest in late VT/VF group (p=0.000). The most significant predictor of late VT/VF was systolic LS (cut off −12.72%, ROC 0.680, Sen 71%, Sp 64%, p=0.006). Conclusions Although late VT/VF occurrence after primary PCI were less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis. The most power predictor of late VT/VF were systolic longitudinal strain. Non-early VT/VF group Early VT/VF group p Non-late VT/VF group Late VT/VF group p (N=222) (N=85) (N=282) (N=25) Ejection fraction (%) 48.40±9.97 46.20±10.35 NS 48.35±9.49 42.23±13.29 0.008 Wall motion score index 1.42±0.34 1.51±0.36 0.041 1.43±0.32 1.58±0.47 0.005 End-diastolic volume index (ml/m2) 51.55±14.40 54.81±16.31 NS 51.72±13.86 59.85±22.64 0.000 End-systolic volume index (ml/m2) 27.22±11.73 29.83±12.36 NS 27.16±19.82 35.15±18.31 0.000 Global LS (%) −13.78±4.40 −13.18±4.32 NS −15.80±4.52 12.80±5.22 0.004 Systolic LS (%) −14.57±4.30 −13.99±4.21 NS −13.07±4.81 −9.88±4.90 0.003 Longitudinal post-systolic shortening (ms) 0.16±0.15 0.17±0.15 NS 0.15±0.10 0.29±0.18 0.003 LS systolic index mechanical dispersion (ms) 40.94±39.62 46.96±42.12 NS 40.44±38.24 64.80±52.02 0.006 MACE (%) 26.1 20.0 NS 3.1 72.0 0.000 Funding Acknowledgement Type of funding source