Antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction

Jonathan P. Piccini, Phillip Schulte, Karen S. Pieper, Rajendra H. Mehta, Harvey D. White, Frans Van De Werf, Diego Ardissino, Robert M. Califf, Christopher B. Granger, E. Magnus Ohman, John H. Alexander

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective: Few data exist to guide antiarrhythmic drug therapy for sustained ventricular tachycardia/ventricular fibrillation after acute myocardial infarction. The objective of this analysis was to describe the survival of patients with sustained ventricular tachycardia/ventricular fibrillation after myocardial infarction according to antiarrhythmic drug treatment. Design and setting: We conducted a retrospective analysis of ST-segment elevation myocardial infarction patients with sustained ventricular tachycardia/ventricular fibrillation in Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO) IIB and GUSTO III and compared all-cause death in patients receiving amiodarone, lidocaine, or no antiarrhythmic. We used Cox proportional-hazards modeling and inverse weighted estimators to adjust for baseline characteristics, β-blocker use, and propensity to receive antiarrhythmics. Due to nonproportional hazards for death in early follow-up (0-3 hrs after sustained ventricular tachycardia/ventricular fibrillation) compared with later follow-up (>3 hrs), we analyzed all-cause mortality using time-specific hazards. Patients and interventions: Among 19,190 acute myocardial infarction patients, 1,126 (5.9%) developed sustained ventricular tachycardia/ventricular fibrillation and met the inclusion criteria. Patients received lidocaine (n = 664, 59.0%), amiodarone (n = 50, 4.4%), both (n = 110, 9.8%), or no antiarrhythmic (n = 302, 26.8%). RESULTS:: In the first 3 hrs after ventricular tachycardia/ventricular fibrillation, amiodarone (adjusted hazard ratio 0.39, 95% confidence interval 0.21-0.71) and lidocaine (adjusted hazard ratio 0.72, 95% confidence interval 0.53-0.96) were associated with a lower hazard of death-likely evidence of survivor bias. Among patients who survived 3 hrs, amiodarone was associated with increased mortality at 30 days (adjusted hazard ratio 1.71, 95% confidence interval 1.02-2.86) and 6 months (adjusted hazard ratio 1.96, 95% confidence interval 1.21-3.16), but lidocaine was not at 30 days (adjusted hazard ratio 1.19, 95% confidence interval 0.77-1.82) or 6 months (adjusted hazard ratio 1.10, 95% confidence interval 0.73-1.66). Conclusion: Among patients with acute myocardial infarction complicated by sustained ventricular tachycardia/ventricular fibrillation who survive 3 hrs, amiodarone, but not lidocaine, is associated with an increased risk of death, reinforcing the need for randomized trials in this population.

Original languageEnglish (US)
Pages (from-to)78-83
Number of pages6
JournalCritical Care Medicine
Volume39
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Anti-Arrhythmia Agents
Ventricular Fibrillation
Ventricular Tachycardia
Cardiac Arrhythmias
Myocardial Infarction
Amiodarone
Drug Therapy
Lidocaine
Confidence Intervals
Mortality
Acute Coronary Syndrome
Survivors
Cause of Death
Coronary Vessels
Survival
Population

Keywords

  • acute coronary syndrome
  • antiarrhythmic drug therapy
  • clinical trials
  • ventricular arrhythmia
  • ventricular fibrillation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction. / Piccini, Jonathan P.; Schulte, Phillip; Pieper, Karen S.; Mehta, Rajendra H.; White, Harvey D.; Van De Werf, Frans; Ardissino, Diego; Califf, Robert M.; Granger, Christopher B.; Ohman, E. Magnus; Alexander, John H.

In: Critical Care Medicine, Vol. 39, No. 1, 01.2011, p. 78-83.

Research output: Contribution to journalArticle

Piccini, JP, Schulte, P, Pieper, KS, Mehta, RH, White, HD, Van De Werf, F, Ardissino, D, Califf, RM, Granger, CB, Ohman, EM & Alexander, JH 2011, 'Antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction', Critical Care Medicine, vol. 39, no. 1, pp. 78-83. https://doi.org/10.1097/CCM.0b013e3181fd6ad7
Piccini, Jonathan P. ; Schulte, Phillip ; Pieper, Karen S. ; Mehta, Rajendra H. ; White, Harvey D. ; Van De Werf, Frans ; Ardissino, Diego ; Califf, Robert M. ; Granger, Christopher B. ; Ohman, E. Magnus ; Alexander, John H. / Antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction. In: Critical Care Medicine. 2011 ; Vol. 39, No. 1. pp. 78-83.
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abstract = "Objective: Few data exist to guide antiarrhythmic drug therapy for sustained ventricular tachycardia/ventricular fibrillation after acute myocardial infarction. The objective of this analysis was to describe the survival of patients with sustained ventricular tachycardia/ventricular fibrillation after myocardial infarction according to antiarrhythmic drug treatment. Design and setting: We conducted a retrospective analysis of ST-segment elevation myocardial infarction patients with sustained ventricular tachycardia/ventricular fibrillation in Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO) IIB and GUSTO III and compared all-cause death in patients receiving amiodarone, lidocaine, or no antiarrhythmic. We used Cox proportional-hazards modeling and inverse weighted estimators to adjust for baseline characteristics, β-blocker use, and propensity to receive antiarrhythmics. Due to nonproportional hazards for death in early follow-up (0-3 hrs after sustained ventricular tachycardia/ventricular fibrillation) compared with later follow-up (>3 hrs), we analyzed all-cause mortality using time-specific hazards. Patients and interventions: Among 19,190 acute myocardial infarction patients, 1,126 (5.9{\%}) developed sustained ventricular tachycardia/ventricular fibrillation and met the inclusion criteria. Patients received lidocaine (n = 664, 59.0{\%}), amiodarone (n = 50, 4.4{\%}), both (n = 110, 9.8{\%}), or no antiarrhythmic (n = 302, 26.8{\%}). RESULTS:: In the first 3 hrs after ventricular tachycardia/ventricular fibrillation, amiodarone (adjusted hazard ratio 0.39, 95{\%} confidence interval 0.21-0.71) and lidocaine (adjusted hazard ratio 0.72, 95{\%} confidence interval 0.53-0.96) were associated with a lower hazard of death-likely evidence of survivor bias. Among patients who survived 3 hrs, amiodarone was associated with increased mortality at 30 days (adjusted hazard ratio 1.71, 95{\%} confidence interval 1.02-2.86) and 6 months (adjusted hazard ratio 1.96, 95{\%} confidence interval 1.21-3.16), but lidocaine was not at 30 days (adjusted hazard ratio 1.19, 95{\%} confidence interval 0.77-1.82) or 6 months (adjusted hazard ratio 1.10, 95{\%} confidence interval 0.73-1.66). Conclusion: Among patients with acute myocardial infarction complicated by sustained ventricular tachycardia/ventricular fibrillation who survive 3 hrs, amiodarone, but not lidocaine, is associated with an increased risk of death, reinforcing the need for randomized trials in this population.",
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AU - Mehta, Rajendra H.

AU - White, Harvey D.

AU - Van De Werf, Frans

AU - Ardissino, Diego

AU - Califf, Robert M.

AU - Granger, Christopher B.

AU - Ohman, E. Magnus

AU - Alexander, John H.

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N2 - Objective: Few data exist to guide antiarrhythmic drug therapy for sustained ventricular tachycardia/ventricular fibrillation after acute myocardial infarction. The objective of this analysis was to describe the survival of patients with sustained ventricular tachycardia/ventricular fibrillation after myocardial infarction according to antiarrhythmic drug treatment. Design and setting: We conducted a retrospective analysis of ST-segment elevation myocardial infarction patients with sustained ventricular tachycardia/ventricular fibrillation in Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO) IIB and GUSTO III and compared all-cause death in patients receiving amiodarone, lidocaine, or no antiarrhythmic. We used Cox proportional-hazards modeling and inverse weighted estimators to adjust for baseline characteristics, β-blocker use, and propensity to receive antiarrhythmics. Due to nonproportional hazards for death in early follow-up (0-3 hrs after sustained ventricular tachycardia/ventricular fibrillation) compared with later follow-up (>3 hrs), we analyzed all-cause mortality using time-specific hazards. Patients and interventions: Among 19,190 acute myocardial infarction patients, 1,126 (5.9%) developed sustained ventricular tachycardia/ventricular fibrillation and met the inclusion criteria. Patients received lidocaine (n = 664, 59.0%), amiodarone (n = 50, 4.4%), both (n = 110, 9.8%), or no antiarrhythmic (n = 302, 26.8%). RESULTS:: In the first 3 hrs after ventricular tachycardia/ventricular fibrillation, amiodarone (adjusted hazard ratio 0.39, 95% confidence interval 0.21-0.71) and lidocaine (adjusted hazard ratio 0.72, 95% confidence interval 0.53-0.96) were associated with a lower hazard of death-likely evidence of survivor bias. Among patients who survived 3 hrs, amiodarone was associated with increased mortality at 30 days (adjusted hazard ratio 1.71, 95% confidence interval 1.02-2.86) and 6 months (adjusted hazard ratio 1.96, 95% confidence interval 1.21-3.16), but lidocaine was not at 30 days (adjusted hazard ratio 1.19, 95% confidence interval 0.77-1.82) or 6 months (adjusted hazard ratio 1.10, 95% confidence interval 0.73-1.66). Conclusion: Among patients with acute myocardial infarction complicated by sustained ventricular tachycardia/ventricular fibrillation who survive 3 hrs, amiodarone, but not lidocaine, is associated with an increased risk of death, reinforcing the need for randomized trials in this population.

AB - Objective: Few data exist to guide antiarrhythmic drug therapy for sustained ventricular tachycardia/ventricular fibrillation after acute myocardial infarction. The objective of this analysis was to describe the survival of patients with sustained ventricular tachycardia/ventricular fibrillation after myocardial infarction according to antiarrhythmic drug treatment. Design and setting: We conducted a retrospective analysis of ST-segment elevation myocardial infarction patients with sustained ventricular tachycardia/ventricular fibrillation in Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO) IIB and GUSTO III and compared all-cause death in patients receiving amiodarone, lidocaine, or no antiarrhythmic. We used Cox proportional-hazards modeling and inverse weighted estimators to adjust for baseline characteristics, β-blocker use, and propensity to receive antiarrhythmics. Due to nonproportional hazards for death in early follow-up (0-3 hrs after sustained ventricular tachycardia/ventricular fibrillation) compared with later follow-up (>3 hrs), we analyzed all-cause mortality using time-specific hazards. Patients and interventions: Among 19,190 acute myocardial infarction patients, 1,126 (5.9%) developed sustained ventricular tachycardia/ventricular fibrillation and met the inclusion criteria. Patients received lidocaine (n = 664, 59.0%), amiodarone (n = 50, 4.4%), both (n = 110, 9.8%), or no antiarrhythmic (n = 302, 26.8%). RESULTS:: In the first 3 hrs after ventricular tachycardia/ventricular fibrillation, amiodarone (adjusted hazard ratio 0.39, 95% confidence interval 0.21-0.71) and lidocaine (adjusted hazard ratio 0.72, 95% confidence interval 0.53-0.96) were associated with a lower hazard of death-likely evidence of survivor bias. Among patients who survived 3 hrs, amiodarone was associated with increased mortality at 30 days (adjusted hazard ratio 1.71, 95% confidence interval 1.02-2.86) and 6 months (adjusted hazard ratio 1.96, 95% confidence interval 1.21-3.16), but lidocaine was not at 30 days (adjusted hazard ratio 1.19, 95% confidence interval 0.77-1.82) or 6 months (adjusted hazard ratio 1.10, 95% confidence interval 0.73-1.66). Conclusion: Among patients with acute myocardial infarction complicated by sustained ventricular tachycardia/ventricular fibrillation who survive 3 hrs, amiodarone, but not lidocaine, is associated with an increased risk of death, reinforcing the need for randomized trials in this population.

KW - acute coronary syndrome

KW - antiarrhythmic drug therapy

KW - clinical trials

KW - ventricular arrhythmia

KW - ventricular fibrillation

KW - ventricular tachycardia

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