Outcomes in patients with sustained ventricular tachyarrhythmias occurring within 48 h of acute myocardial infarction: when is ICD appropriate?

Jackson J. Liang, David O. Hodge, Ramila A. Mehta, Andrea M. Russo, Abhiram Prasad, Yong-Mei Cha

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10 Citations (Scopus)

Abstract

AIMS: Recent guidelines for implantable cardioverter-defibrillator (ICD) use in patients with early ventricular arrhythmia (VA) after acute myocardial infarction (MI) are based on systolic function and revascularization status, yet decision to implant an ICD remains highly subjective. We aimed to determine characteristics, utilization of ICDs, and long-term outcomes of survivors of early VA (<48 h) after acute MI.

METHODS AND RESULTS: We retrospectively analyzed clinical characteristics, ICD therapies, and survival in 128 patients with early VA after acute MI from 2002-12. Patients were classified for appropriateness of ICD implantation, per 2013 Appropriate Use Criteria (AUC). In 128 early VA survivors after MI, older age, female gender, history of coronary artery bypass graft surgery (CABG) or MI, non-ST-elevation MI or ventricular tachycardia (VT) at presentation predicted worse overall survival (all P < 0.05). While left ventricular ejection fraction (LVEF) did not predict mortality (HR = 1; P = 0.86), post-MI ventricular fibrillation (VF) portended a better long-term prognosis than VT (HR = 0.37; P = 0.001). Twenty-six (20%) early VA survivors received ICD, corresponding well with AUC. Implantable cardioverter-defibrillator recipients had lower post-MI LVEF (P = 0.02) and more frequently presented with non-ST-elevation MI (P = 0.007). Over 2.4 years of median follow-up, ICD recipients had a greater mortality rate than non-ICD recipients (42 vs. 17%; P = 0.02). Appropriate and inappropriate ICD discharges were high in ICD recipients.

CONCLUSION: Early VA survivors after MI receiving ICD due to suspected non-reversible arrhythmogenic substrate have high rates of appropriate ICD therapy and mortality. Our ICD implantation practice corresponds well with the AUC. Sustained monomorphic VT and non-ST-elevation MI at presentation predict increased risk for death. Larger prospective studies are necessary to confirm our findings, such as to provide evidence for future ICD guidelines.

Fingerprint

Implantable Defibrillators
Tachycardia
Myocardial Infarction
Cardiac Arrhythmias
Survivors
Ventricular Tachycardia
Stroke Volume
Mortality
Guidelines
Defibrillators
Survival
Ventricular Fibrillation
Coronary Artery Bypass

Keywords

  • Appropriateness
  • Implantable cardioverter-defibrillator
  • Myocardial infarction
  • Sudden cardiac death
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{b374e89e472d42689cbfb55080201276,
title = "Outcomes in patients with sustained ventricular tachyarrhythmias occurring within 48 h of acute myocardial infarction: when is ICD appropriate?",
abstract = "AIMS: Recent guidelines for implantable cardioverter-defibrillator (ICD) use in patients with early ventricular arrhythmia (VA) after acute myocardial infarction (MI) are based on systolic function and revascularization status, yet decision to implant an ICD remains highly subjective. We aimed to determine characteristics, utilization of ICDs, and long-term outcomes of survivors of early VA (<48 h) after acute MI.METHODS AND RESULTS: We retrospectively analyzed clinical characteristics, ICD therapies, and survival in 128 patients with early VA after acute MI from 2002-12. Patients were classified for appropriateness of ICD implantation, per 2013 Appropriate Use Criteria (AUC). In 128 early VA survivors after MI, older age, female gender, history of coronary artery bypass graft surgery (CABG) or MI, non-ST-elevation MI or ventricular tachycardia (VT) at presentation predicted worse overall survival (all P < 0.05). While left ventricular ejection fraction (LVEF) did not predict mortality (HR = 1; P = 0.86), post-MI ventricular fibrillation (VF) portended a better long-term prognosis than VT (HR = 0.37; P = 0.001). Twenty-six (20{\%}) early VA survivors received ICD, corresponding well with AUC. Implantable cardioverter-defibrillator recipients had lower post-MI LVEF (P = 0.02) and more frequently presented with non-ST-elevation MI (P = 0.007). Over 2.4 years of median follow-up, ICD recipients had a greater mortality rate than non-ICD recipients (42 vs. 17{\%}; P = 0.02). Appropriate and inappropriate ICD discharges were high in ICD recipients.CONCLUSION: Early VA survivors after MI receiving ICD due to suspected non-reversible arrhythmogenic substrate have high rates of appropriate ICD therapy and mortality. Our ICD implantation practice corresponds well with the AUC. Sustained monomorphic VT and non-ST-elevation MI at presentation predict increased risk for death. Larger prospective studies are necessary to confirm our findings, such as to provide evidence for future ICD guidelines.",
keywords = "Appropriateness, Implantable cardioverter-defibrillator, Myocardial infarction, Sudden cardiac death, Ventricular arrhythmia",
author = "Liang, {Jackson J.} and Hodge, {David O.} and Mehta, {Ramila A.} and Russo, {Andrea M.} and Abhiram Prasad and Yong-Mei Cha",
year = "2014",
month = "12",
day = "1",
doi = "10.1093/europace/euu138",
language = "English (US)",
volume = "16",
pages = "1759--1766",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "12",

}

TY - JOUR

T1 - Outcomes in patients with sustained ventricular tachyarrhythmias occurring within 48 h of acute myocardial infarction

T2 - when is ICD appropriate?

AU - Liang, Jackson J.

AU - Hodge, David O.

AU - Mehta, Ramila A.

AU - Russo, Andrea M.

AU - Prasad, Abhiram

AU - Cha, Yong-Mei

PY - 2014/12/1

Y1 - 2014/12/1

N2 - AIMS: Recent guidelines for implantable cardioverter-defibrillator (ICD) use in patients with early ventricular arrhythmia (VA) after acute myocardial infarction (MI) are based on systolic function and revascularization status, yet decision to implant an ICD remains highly subjective. We aimed to determine characteristics, utilization of ICDs, and long-term outcomes of survivors of early VA (<48 h) after acute MI.METHODS AND RESULTS: We retrospectively analyzed clinical characteristics, ICD therapies, and survival in 128 patients with early VA after acute MI from 2002-12. Patients were classified for appropriateness of ICD implantation, per 2013 Appropriate Use Criteria (AUC). In 128 early VA survivors after MI, older age, female gender, history of coronary artery bypass graft surgery (CABG) or MI, non-ST-elevation MI or ventricular tachycardia (VT) at presentation predicted worse overall survival (all P < 0.05). While left ventricular ejection fraction (LVEF) did not predict mortality (HR = 1; P = 0.86), post-MI ventricular fibrillation (VF) portended a better long-term prognosis than VT (HR = 0.37; P = 0.001). Twenty-six (20%) early VA survivors received ICD, corresponding well with AUC. Implantable cardioverter-defibrillator recipients had lower post-MI LVEF (P = 0.02) and more frequently presented with non-ST-elevation MI (P = 0.007). Over 2.4 years of median follow-up, ICD recipients had a greater mortality rate than non-ICD recipients (42 vs. 17%; P = 0.02). Appropriate and inappropriate ICD discharges were high in ICD recipients.CONCLUSION: Early VA survivors after MI receiving ICD due to suspected non-reversible arrhythmogenic substrate have high rates of appropriate ICD therapy and mortality. Our ICD implantation practice corresponds well with the AUC. Sustained monomorphic VT and non-ST-elevation MI at presentation predict increased risk for death. Larger prospective studies are necessary to confirm our findings, such as to provide evidence for future ICD guidelines.

AB - AIMS: Recent guidelines for implantable cardioverter-defibrillator (ICD) use in patients with early ventricular arrhythmia (VA) after acute myocardial infarction (MI) are based on systolic function and revascularization status, yet decision to implant an ICD remains highly subjective. We aimed to determine characteristics, utilization of ICDs, and long-term outcomes of survivors of early VA (<48 h) after acute MI.METHODS AND RESULTS: We retrospectively analyzed clinical characteristics, ICD therapies, and survival in 128 patients with early VA after acute MI from 2002-12. Patients were classified for appropriateness of ICD implantation, per 2013 Appropriate Use Criteria (AUC). In 128 early VA survivors after MI, older age, female gender, history of coronary artery bypass graft surgery (CABG) or MI, non-ST-elevation MI or ventricular tachycardia (VT) at presentation predicted worse overall survival (all P < 0.05). While left ventricular ejection fraction (LVEF) did not predict mortality (HR = 1; P = 0.86), post-MI ventricular fibrillation (VF) portended a better long-term prognosis than VT (HR = 0.37; P = 0.001). Twenty-six (20%) early VA survivors received ICD, corresponding well with AUC. Implantable cardioverter-defibrillator recipients had lower post-MI LVEF (P = 0.02) and more frequently presented with non-ST-elevation MI (P = 0.007). Over 2.4 years of median follow-up, ICD recipients had a greater mortality rate than non-ICD recipients (42 vs. 17%; P = 0.02). Appropriate and inappropriate ICD discharges were high in ICD recipients.CONCLUSION: Early VA survivors after MI receiving ICD due to suspected non-reversible arrhythmogenic substrate have high rates of appropriate ICD therapy and mortality. Our ICD implantation practice corresponds well with the AUC. Sustained monomorphic VT and non-ST-elevation MI at presentation predict increased risk for death. Larger prospective studies are necessary to confirm our findings, such as to provide evidence for future ICD guidelines.

KW - Appropriateness

KW - Implantable cardioverter-defibrillator

KW - Myocardial infarction

KW - Sudden cardiac death

KW - Ventricular arrhythmia

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U2 - 10.1093/europace/euu138

DO - 10.1093/europace/euu138

M3 - Article

C2 - 25100756

AN - SCOPUS:84937511536

VL - 16

SP - 1759

EP - 1766

JO - Europace

JF - Europace

SN - 1099-5129

IS - 12

ER -