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Background:Lethal arrhythmias including ventricular tachycardia and fibrillation (VT/VF) are common complications of acute myocardial infarction (AMI). Predictors of in-hospital VT/VF after AMI, however, have not been thoroughly investigated. In this study, we sought to elucidate the predictors of in-hospital VT/VF events after AMI in the Japanese...
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Context 1
... median age was 69 years, and 25% were female. Table 1 lists patient clinical background and the characteristics of AMI in this study. In-hospital VT/VF events were observed in 114 patients (VT/VF group), which was 3.7% of the total enrolled patients (the others were defined as the non-VT/ VF group; n=3,061). ...Similar publications
Purpose
We sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China.
Methods
Data from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed.
Results
Of the 1,988 patients with right ventricular in...
Citations
... MVA group and non-MVA group were distinguished with each other according to whether MVA occurred after PCI in the training set. Inclusion criteria: (1) All patients met the diagnosis and treatment criteria of acute myocardial infarction [17], MVA diagnosis met the relevant diagnostic criteria [18,19]; (2) All patients completed myocardial enzyme spectrum, troponin, coronary angiography and ECG detection, and patients can tolerate emergency PCI; (3) Aged > 18 years old; (4) Patients with integral clinical data. As for exclusion criteria: (1) previous myocardial infarction; (2) combined with severe metabolic system diseases; (3) combined with severe liver and kidney and other organ dysfunction; (4) combined with severe infection; (5) combined with coagulation dysfunction; (6) recent history of major surgical trauma; (7) malignant ventricular arrhythmia at admission before PCI. ...
Objective:
To make predictions about the risk of MVA (Malignant Ventricular Arrhythmia) after primary PCI (Percutaneous Coronary Intervention) in patients with AMI (Acute Myocardial Infarction) through constructing and validating the Nomogram model.
Methods:
311 AMI patients who suffered from emergency PCI in Hefei Second People's Hospital from January 2020 to May 2023 were selected as the training set; 253 patients suffering from the same symptom in Hefei First People's Hospital during the same period were selected as the validation set. Risk factors were further screened by means of multivariate logistic and stepwise regression. The nomogram model was constructed, and then validated by using C-index, ROC curve, decision curve and calibration curve.
Results:
Multivariate logistic analysis revealed that urea, systolic pressure, hypertension, Killip class II-IV, as well as LVEF (Left Ventricular Ejection Fraction) were all unrelated hazards for MVA after emergency PCI for AMI (P<0.05); a risk prediction nomogram model was constructed. The C-index was calculated to evaluate the predictive ability of the model. Result showed that the index of the training and the validation set was 0.783 (95% CI: 0.726-0.84) and 0.717 (95% CI: 0.65-0.784) respectively, which suggested that the model discriminated well. Meanwhile, other tools including ROC curve, calibration curve and decision curve also proved that this nomogram plays an effective role in forecasting the risk for MVA after PCI in AMI patients.
Conclusions:
The study successfully built the nomogram model and made predictions for the development of MVA after PCI in AMI patients.
... Among these, 14 patients succumbed, resulting in a mortality rate of 15.73%. 26,27 This underlines that the occurrence rate of MVA in elderly AMI patients is notably high, and so is the mortality rate, warranting significant clinical attention. In this study, it was observed that the expression levels of CRP were notably elevated in elderly AMI patients who developed MVA compared to those without MVA. ...
Objective
To investigate the association of S100A12 protein and C-reactive protein (CRP) with the onset of malignant ventricular arrhythmias (MVA) after acute myocardial infarction (AMI) in the elderly.
Methods
A total of 159 elderly AMI patients admitted to Chongming Hospital affiliated to Shanghai University of Medicine & Health Sciences from January 2018 to January 2023 were enrolled in the study. CRP levels were determined using an automatic biochemical analyzer, and S100A12 levels were measured using enzyme-linked immunosorbent assay (ELISA). Patients were categorized based on the Lown classification into groups without MVA and with MVA. Univariate analysis was initially performed to identify independent variables, followed by multivariate logistic regression to determine the risk factors for malignant ventricular arrhythmias post-AMI. The predictive value of S100A12 protein and CRP for malignant ventricular arrhythmias after acute myocardial infarction in the elderly was analyzed using the receiver operating characteristic (ROC) curve.
Results
Among the 159 patients with AMI, 27 (17%) had MVA. Multivariate logistic regression analysis indicated that both S100A12 protein and CRP could be independent risk factors for malignant ventricular arrhythmias following acute myocardial infarction in the elderly (p < 0.05). The area under the ROC curve showed the area under the curve (AUC) for S100A12 protein to be 0.7147, for CRP 0.7356, and for the combined diagnosis 0.8350 (p < 0.05).
Conclusion
S100A12 protein and CRP are independent risk factors for MVA after MI in the elderly. The combined application of S100A12 protein and CRP has higher diagnostic sensitivity and specificity.
... The incidence of fatal arrhythmias varies from 3.7% to 42%, depending on the study population. [19][20][21][22][23] Similar to our results, in various recent studies, at least the second most common arrhythmia was AIVR, whose incidence ranged from about 42% to 50%. 18,19,21 In line with 2 sizable observational studies, in the present study, the frequencies of hypertension, diabetes mellitus, and a history of AMI as the risk factors for AMI were about 50%, 20%, and 15%, respectively. ...
Background: Ventricular arrhythmias (VAs), which result from acute myocardial infarction and revascularization, are preventable causes of sudden cardiac death. This study aimed to determine the incidence, types, and risk factors of VAs in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).
Methods: This cross-sectional study was conducted at the cardiology department of a tertiary care cardiac center in Zanjan, Iran. All the patients were monitored during hospitalization, and the incidence of cardiac arrhythmias and the outcomes were recorded.
Result: Among 315 patients, the mean age was 62.14±10.11 years, and 76.2% were male. Male gender was significantly associated with VA occurrence (P=0.038). Among the patients, 50.5% had VAs, of which 26.4% were sustained ventricular tachycardia (sustained VT) and ventricular fibrillation (VF). Sustained VT and VF, but not total arrhythmias, were more common in anterior infarctions. Most arrhythmias occurred during the first 12 hours, and frequent premature ventricular contractions (43.3%) and idioventricular rhythm (20.1%) were the most common. A history of PCI and coronary artery bypass grafting (CABG) was associated with substantially reduced arrhythmias (P=0.017 and P=0.013, respectively). However, cardiovascular risk factors exerted no statistically significant effects on the VA type.
Conclusion: Approximately half of our patients experienced reperfusion-induced VAs. Overall, gender and a history of PCI and CABG were significantly associated with VA occurrence. Therefore, males and patients without a positive history of PCI and CABG should receive antiarrhythmic drugs as a precaution.
... It encompasses several lethal arrhythmic phenomena, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF), pulseless electrical activity (PEA), and asystole. All of which need emergent advanced cardiac life support (ACLS) and are associated with a substantial risk of death [6][7][8]. To date, several risk factors contributing to LTA in pPCI-treated patients were reported in several categories, such as the patient age, underlying diseases (e.g., chronic kidney disease), clinical presentation (e.g., Killip classification III or IV), vital signs (e.g., lower baseline heart rate), initial findings in electrocardiogram or echocardiography (e.g., baseline ST deviation, lower ejection fraction (EF)), initial laboratory investigations (e.g., lower hematocrit, higher white blood cell count, higher baseline serum creatinine), findings from coronary angiogram (CAG), and pPCI (e.g., pre PCI thrombolysis in myocardial infarction (TIMI) flow grade, ST resolution, post PCI TIMI flow grade) [7,8]. ...
... All of which need emergent advanced cardiac life support (ACLS) and are associated with a substantial risk of death [6][7][8]. To date, several risk factors contributing to LTA in pPCI-treated patients were reported in several categories, such as the patient age, underlying diseases (e.g., chronic kidney disease), clinical presentation (e.g., Killip classification III or IV), vital signs (e.g., lower baseline heart rate), initial findings in electrocardiogram or echocardiography (e.g., baseline ST deviation, lower ejection fraction (EF)), initial laboratory investigations (e.g., lower hematocrit, higher white blood cell count, higher baseline serum creatinine), findings from coronary angiogram (CAG), and pPCI (e.g., pre PCI thrombolysis in myocardial infarction (TIMI) flow grade, ST resolution, post PCI TIMI flow grade) [7,8]. Interestingly, there was heterogeneity among past studies regarding the follow-up period, ranging from 12 h to even a week after pPCI [6][7][8]. ...
... To date, several risk factors contributing to LTA in pPCI-treated patients were reported in several categories, such as the patient age, underlying diseases (e.g., chronic kidney disease), clinical presentation (e.g., Killip classification III or IV), vital signs (e.g., lower baseline heart rate), initial findings in electrocardiogram or echocardiography (e.g., baseline ST deviation, lower ejection fraction (EF)), initial laboratory investigations (e.g., lower hematocrit, higher white blood cell count, higher baseline serum creatinine), findings from coronary angiogram (CAG), and pPCI (e.g., pre PCI thrombolysis in myocardial infarction (TIMI) flow grade, ST resolution, post PCI TIMI flow grade) [7,8]. Interestingly, there was heterogeneity among past studies regarding the follow-up period, ranging from 12 h to even a week after pPCI [6][7][8]. ...
ST-elevated acute coronary syndrome (STEACS) is a serious condition requiring timely treatment. Reperfusion with primary percutaneous coronary intervention (pPCI) is recommended and preferred over fibrinolysis. Despite its efficacy, lethal complications, such as life-threatening arrhythmia (LTA), are common in post-PCI patients. Although various risk assessment tools were developed, only a few focus on LTA prediction. This study aimed to develop a risk score to predict LTA events after pPCI. A risk score was developed using a retrospective cohort of consecutive patients with STEACS who underwent pPCI at Chiangrai Prachanukroh Hospital from January 2012 to December 2016. LTA is defined as the occurrence of malignant arrhythmia that requires advanced cardiovascular life support (ACLS) within 72 h after pPCI. Logistic regression was used for model derivation. Among 273 patients, 43 (15.8%) developed LTA events. Seven independent predictors were identified: female sex, hemoglobin <12 gm/dL, pre-and intra- procedural events (i.e., respiratory failure and pulseless arrest), IABP insertion, intervention duration >60 min, and desaturation after pPCI. The LTA score showed an AuROC of 0.93 (95%CI 0.90, 0.97). The score was categorized into three risk categories: low (<2.5), moderate (2.5–4), and high risk (>4) for LTA events. The LTA score demonstrated high predictive performance and potential clinical utility for predicting LTA events after pPCI.
... In terms of data derived from Japanese population, there are several registries and databases including patients with AMI in Japan such as J-MINUET [25][26][27][28], PACIFIC [29], Tokyo CCU network registry [30], JAMIR [31][32][33][34][35], and JROAD [36][37][38]. CVIT has been working on the J-PCI registry [39][40][41][42], the largest database of patients who underwent PCI in Japan. ...
Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.
... [10][11][12] Non-sustained ventricular tachyarrhythmia, which is often documented in the acute phase after AMI, is also a reported risk factor for ventricular tachycardia or ventricular fibrillation in patients with reduced LVEF. 13,14 However, little is known regarding which patients with heart failure after AMI should be considered for prophylactic therapies, such as an implantable cardioverter-defibrillator. This study aimed to investigate the prognostic factors and significance of VAs in the late phase among patients with reduced LVEF after AMI. ...
... The J-MINUET study recently showed that in-hospital ventricular tachycardia or ventricular fibrillation after AMI were predicted by higher creatine kinase concentrations, Killip class III-IV, initial thrombolysis in myocardial infarction flow grade 0-1, and concomitant chronic kidney disease. 13 However, we did not have access to data regarding Killip classification or initial thrombolysis in myocardial infarction flow grade, although the univariate analyses revealed that sustained ventricular tachycardia or ventricular fibrillation in the late phase after AMI were predicted by peak creatine phosphokinase concentration and the presence of non-sustained ventricular tachyarrhythmia in the sub-acute phase after AMI. These results are consistent with previously reported results, 26,27 although the relationships were not significant in our multivariable analysis. ...
... 28 In the acute and sub-acute phases after AMI, reperfusion arrhythmias occur because of free radicals that are produced when the myocardium is hypo-perfused, and the severity of ischaemia is associated with the prevalence of reperfusion arrhythmia. 13,29 The main mechanism of VAs is thought to be abnormal automaticity within 2 weeks after AMI. During this period, the damaged myocardium is replaced by a fibrotic scar that could be the source of abnormal automaticity. ...
Aims
Little is known regarding factors that predict the occurrence of lethal ventricular arrhythmias (VAs) occurring after acute myocardial infarction (AMI). This observational cohort study aimed to identify factors that predicted lethal VAs during the late phase after AMI in patients with reduced left ventricular ejection fraction (LVEF).
Methods and results
Data were collected from our AMI database regarding consecutive patients with an LVEF of ≤40% after AMI (January 2012 to July 2018). The ‘late phase’ was defined as ≥7 days after AMI onset, and the primary endpoint was defined as lethal VAs in the late phase. The study included 136 patients (82% men; mean age: 66 ± 13 years). The average LVEF at admission was 32.7 ± 8.2%. During a mean follow-up period of 20.7 months, 14 patients (10%) experienced lethal VAs, including ventricular fibrillation (n = 8) and sustained ventricular tachycardia (n = 10). Univariate analyses revealed that lethal VAs were predicted by age and LVEF at admission. Receiver operating characteristic curve analysis indicated that the optimal cut-off value was 23% for using the LVEF at admission to predict the primary endpoint (area under the curve: 0.77, P < 0.0001). Multivariable analysis also demonstrated that LVEF at admission was an independent predictor of the primary endpoint (risk ratio = 7.12, P = 0.001).
Conclusions
Lethal VAs in the late phase are common in patients with AMI, and reduced LVEF and cardiac function at admission play a significant role in the risk stratification for future lethal VAs in this population.
Objective. Most studies analyzing predictors of sudden cardiac death (SCD) after acute myocardial infarction included only high-risk patients or index reperfusion had not been performed in all patients. The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of unselected patients with ST-elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (pPCI). Method. we analysed 3114 STEMI patients included included in the University Clinical Center of Serbia STEMI Register. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge. Results. During 6-year follow-up, lethal outcome was registered in 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e. 0.8% of the patients analyzed. The independent predictors for the occurrence of SCD during 6-year follow-up were EF < 45% (HR 3.07, 95% 1.87–5.02), post-procedural TIMI flow <3 (HR 2.59, 95%CI 1.37–5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12–2.93) and Killip class >1 at admission (HR 1.69, 95%CI 1.23–2.97). Conclusion. There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. Predictors of SCD occurence during long-term follow-up in analyzed patients are clinical variables that are easily recorded during index hospitalization and include: EF ≤45%, post-procedural flow TIMI < 3, Killip class >1, and reduced baseline kidney function.
Background: The hypothesis of this study is that latent class analysis could identify the subphenotypes of out-of-hospital cardiac arrest (OHCA) patients associated with the outcomes and allow us to explore heterogeneity in the effects of extracorporeal cardio�pulmonary resuscitation (ECPR).
Methods and Results: This study was a retrospective analysis of a multicenter prospective observational study (CRITICAL study) of OHCA patients. It included adult OHCA patients with initial shockable rhythm. Patients from 2012 to 2016 (development dataset) were included in the latent class analysis, and those from 2017 (validation dataset) were included for evaluation. The association between subphenotypes and outcomes was investigated. Further, the heterogeneity of the association between ECPR implementa�tion and outcomes was explored. In the study results, a total of 920 patients were included for latent class analysis. Three subphe�notypes (Groups 1, 2, and 3) were identified, mainly characterized by the distribution of partial pressure of O2 (PO2), partial pressure of CO2 (PCO2) value of blood gas assessment, cardiac rhythm on hospital arrival, and estimated glomerular filtration rate. The 30-day survival outcomes were varied across the groups: 15.7% in Group 1; 30.7% in Group 2; and 85.9% in Group 3. Further, the asso�ciation between ECPR and 30-day survival outcomes by subphenotype groups in the development dataset was as varied. These results were validated using the validation dataset.
Conclusions: The latent class analysis identified 3 subphenotypes with different survival outcomes and potential heterogeneity in the effects of ECPR.
