Sustained ventricular arrhythmias among patients with acute coronary syndromes with no ST-segment elevation - Incidence, predictors, and outcomes

被引:106
作者
Al-Khatib, SM
Granger, CB
Huang, Y
Lee, KL
Califf, RM
Simoons, ML
Armstrong, PW
Van de Werf, F
White, HD
Simes, RJ
Moliterno, DJ
Topol, EJ
Harrington, RA
机构
[1] Duke Clin Res Inst, Durham, NC 27715 USA
[2] Univ Rotterdam, Rotterdam, Netherlands
[3] Univ Alberta, Edmonton, AB, Canada
[4] Univ Hosp Gasthuisberg, B-3000 Louvain, Belgium
[5] Green Lane Hosp, Auckland 3, New Zealand
[6] Univ Sydney, Sydney, NSW 2006, Australia
[7] Cleveland Clin Fdn, Cleveland, OH 44195 USA
关键词
coronary disease; tachycardia; fibrillation; prognosis; mortality;
D O I
10.1161/01.CIR.0000022692.49934.E3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The prognosis of ventricular arrhythmias among patients with non-ST-elevation acute coronary syndromes is unknown. We studied the incidence, predictors, and outcomes of sustained ventricular arrhythmias in 4 large randomized trials of such patients. Methods and Results-We pooled the datasets of the Global Use of Streptokinase and tPA for Occluded Arteries (GUSTO)-IIb, Platelet Glycoprotein Ilb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network (PARAGON)-A, and PARAGON-B trials (n=26 416). We identified independent predictors of ventricular fibrillation (VF) and ventricular tachycardia (VT) and compared the 30-day and 6-month mortality rates of patients who did (n=552) and did not (n=25 864) develop these arrhythmias during the index hospitalization. Independent predictors of in-hospital VF included prior hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, and ST-segment changes at presentation. Except for hypertension, these variables also independently predicted in-hospital VT. In Cox proportional-hazards modeling, in-hospital VF and VT were independently associated with 30-day mortality (hazard ratio [HR], 23.2 [95% CI, 18.1 to 29.8] for VF and HR, 7.6 [95% CI, 5.5 to 10.4] for VT) and 6-month mortality (HR, 14.8 [95% CI, 12.1 to 18.3] for VF and HR, 5.0 [95% CI, 3.8 to 6.5] for VT). These differences remained significant after excluding patients with heart failure or cardiogenic shock and those who died <24 hours after enrollment. Conclusions-Despite the use of effective therapies for non-ST-elevation acute coronary syndromes, ventricular arrhythmias in this setting are associated with increased 30-day and 6-month mortality. More effective therapies are needed to improve the survival of patients with these arrhythmias.
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页码:309 / 312
页数:4
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