Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era

Masaharu Masuda; Daisaku Nakatani; Shungo Hikoso; Shinichiro Suna; Masaya Usami; Sen Matsumoto; Tetsuhisa Kitamura; Hitoshi Minamiguchi; Yuji Okuyama; Masaaki Uematsu; Takahisa Yamada; Katsuomi Iwakura; Toshimitsu Hamasaki; Yasuhiko Sakata; Hiroshi Sato; Shinsuke Nanto; Masatsugu Hori; Issei Komuro; Yasushi Sakata; on behalf of the OACIS investigators

doi:10.1253/circj.CJ-16-0183

Arrhythmia/Electrophysiology

Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era

Masaharu Masuda, Daisaku Nakatani, Shungo Hikoso, Shinichiro Suna, Masaya Usami, Sen Matsumoto, Tetsuhisa Kitamura, Hitoshi Minamiguchi, Yuji Okuyama, Masaaki Uematsu, Takahisa Yamada, Katsuomi Iwakura, Toshimitsu Hamasaki, Yasuhiko Sakata, Hiroshi Sato, Shinsuke Nanto, Masatsugu Hori, Issei Komuro, Yasushi Sakata, on behalf of the OACIS investigators

Author information

Masaharu Masuda
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Cardiovascular Center, Kansai Rosai Hospital
Daisaku Nakatani
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Shungo Hikoso
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Shinichiro Suna
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Masaya Usami
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Sen Matsumoto
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Tetsuhisa Kitamura
Department of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
Hitoshi Minamiguchi
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Yuji Okuyama
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Masaaki Uematsu
Cardiovascular Center, Kansai Rosai Hospital
Takahisa Yamada
Department of Cardiology, Osaka General Medical Center
Katsuomi Iwakura
Cardiovascular Center, Sakurabashi Watanabe Hospital
Toshimitsu Hamasaki
Office of Biostatistics and Data Management, National Cerebral and Cardiovascular Center
Yasuhiko Sakata
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
Hiroshi Sato
School of Human Welfare Studies Health Care Center and Clinic Kwansei Gakuin
Shinsuke Nanto
Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine
Masatsugu Hori
Osaka Prefectural Hospital Organization, Osaka Medical Center for Cancer and Cardiovascular Disease
Issei Komuro
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
Yasushi Sakata
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
on behalf of the OACIS investigators

Keywords: Acute myocardial infarction, Percutaneous coronary intervention, Prognosis, Ventricular tachycardia, Ventricular fibrillation

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Supplementary material

2016 Volume 80 Issue 7 Pages 1539-1547

DOI https://doi.org/10.1253/circj.CJ-16-0183

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Abstract

Background:The aim of this study was to investigate the prognostic impact of acute-phase ventricular tachycardia and fibrillation (VT/VF) on ST-segment elevation myocardial infarction (STEMI) patients in the percutaneous coronary intervention (PCI) era.Methods and Results:Using the database of the Osaka Acute Coronary Insufficiency Study (OACIS), we studied 4,283 consecutive patients with STEMI who were hospitalized within 12 h of STEMI onset and underwent emergency PCI. Acute-phase VT/VF, defined as ≥3 consecutive ventricular premature complexes and/or VF within the 1st week of hospitalization, occurred in 997 (23.3%) patients. In-hospital mortality risk was significantly higher in patients with acute-phase VT/VF than inthose without (14.6% vs. 4.3%, adjusted hazard ratio (HR) 1.83, P=0.0013). Among patients discharged alive, 5-year mortality rates were comparable between patients with and without acute-phase VT/VF. Subgroup analysis showed that acute-phase VT/VF was associated with increased 5-year mortality after discharge in high-risk patients (GRACE Risk Score ≥115; adjusted HR 1.60, P=0.043), but not in intermediate- or low-risk patients.Conclusions:Even in the PCI era, acute-phase VT/VF was associated with higher in-hospital deaths of STEMI patients. However, the 5-year prognostic impact of acute-phase VT/VF was limited to high-risk patients. (Circ J 2016; 80: 1539–1547)

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